1,098 results on '"BURKERT, A."'
Search Results
2. Diarrhea duration and performance outcomes of pre-weaned dairy calves supplemented with bacteriophage
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Evandro Schmoeller, Francisco Augusto Burkert Del Pino, Viviane Rohrig Rabassa, Natalia Machado Rahal, Cássio Cassal Brauner, Marcio Nunes Corrêa, Adriane Dalla Costa de Matos, and Miss Josiane Feijó
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Veterinary medicine ,biology ,Phage therapy ,business.industry ,medicine.medical_treatment ,biology.organism_classification ,Crossbreed ,Bacteriophage ,Diarrhea ,Lytic cycle ,Food Animals ,Medicine ,Animal Science and Zoology ,medicine.symptom ,business - Abstract
This study aimed to evaluate lytic bacteriophage supplementation in pre-weaned dairy calves over neonatal calf diarrhea and respiratory diseases occurrence, performance and biochemical parameters. Also, to determine bacterial agents causing NCD. Two hundred Holstein×Gyr crossbred female calves were divided into two groups: Control (CON, n = 100), no supplementation; and Bacteriophage (PHAGE, n = 100) bacteriophage supplementation (1 g/day) from d 3 until d 70 of life. Calves were monitored daily for respiratory disease and diarrhea, as for age at the first diarrheic episode and its duration. Fecal samples were cultured for isolation of Escherichia coli and Salmonella spp. colonies and PCR was performed to identify E. coli virulence genes and to confirm Salmonella spp. Performance outcomes were evaluated up to 80 d of age. Blood samples were collected to determine serum levels of total proteins, albumin, cholesterol, γ-glutamyl transferase and urea. PHAGE group had fewer days in diarrhea and duration of the first episode was lower, compared to CON group. Fecal samples of three animals in PHAGE and nine in CON were positive for E. coli in PCR. Thoracic perimeter tended to be higher in supplemented animals. Average daily gain mean of PHAGE was higher in the first 30 d of life, at the beginning of step-down weaning (up to 42 d) and after weaning (up to 80 d). PHAGE mean was lower for albumin and higher for urea. Therefore, phage therapy during the pre-weaned period reduced the duration of neonatal diarrhea, providing greater weight gain for calves.
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- 2022
3. Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study
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Volpicelli, G., Gargani, L., Perlini, S., Spinelli, S., Barbieri, G., Lanotte, A., Casasola, G. G., Nogue-Bou, R., Lamorte, A., Agricola, E., Villen, T., Deol, P. S., Nazerian, P., Corradi, F., Stefanone, V., Fraga, D. N., Navalesi, P., Ferre, R., Boero, E., Martinelli, G., Cristoni, L., Perani, C., Vetrugno, L., Mcdermott, C., Miralles-Aguiar, F., Secco, G., Zattera, C., Salinaro, F., Grignaschi, A., Boccatonda, A., Giostra, F., Infante, M. N., Covella, M., Ingallina, G., Burkert, J., Frumento, P., Forfori, F., Ghiadoni, L., Fraccalini, T., Vendrame, A., Basile, V., Cipriano, A., Frassi, F., Santini, M., Falcone, M., Menichetti, F., Barcella, B., Delorenzo, M., Resta, F., Vezzoni, G., Bonzano, M., Briganti, D. F., Cappa, G., Zunino, I., Demitry, L., Vignaroli, D., Dipietro, L. S. S., Bazzini, M., Capozza, V., Gonzalez, M. M., Gibal, R. V., Ibarz, R. P., Alfaro, L. M., Alfaro, C. M., Alins, M. G., Brown, A., Dunlop, H., Ralli, M. L., Persona, P., Russel, F. M., Pang, P. S., Rovida, S., Deana, C., Franchini, D., Gargani, Luna, Volpicelli, G., Gargani, L., Perlini, S., Spinelli, S., Barbieri, G., Lanotte, A., Casasola, G. G., Nogue-Bou, R., Lamorte, A., Agricola, E., Villen, T., Deol, P. S., Nazerian, P., Corradi, F., Stefanone, V., Fraga, D. N., Navalesi, P., Ferre, R., Boero, E., Martinelli, G., Cristoni, L., Perani, C., Vetrugno, L., Mcdermott, C., Miralles-Aguiar, F., Secco, G., Zattera, C., Salinaro, F., Grignaschi, A., Boccatonda, A., Giostra, F., Infante, M. N., Covella, M., Ingallina, G., Burkert, J., Frumento, P., Forfori, F., Ghiadoni, L., Fraccalini, T., Vendrame, A., Basile, V., Cipriano, A., Frassi, F., Santini, M., Falcone, M., Menichetti, F., Barcella, B., Delorenzo, M., Resta, F., Vezzoni, G., Bonzano, M., Briganti, D. F., Cappa, G., Zunino, I., Demitry, L., Vignaroli, D., Dipietro, L. S. S., Bazzini, M., Capozza, V., Gonzalez, M. M., Gibal, R. V., Ibarz, R. P., Alfaro, L. M., Alfaro, C. M., Alins, M. G., Brown, A., Dunlop, H., Ralli, M. L., Persona, P., Russel, F. M., Pang, P. S., Rovida, S., Deana, C., and Franchini, D.
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Adult ,medicine.medical_specialty ,Multivariate analysis ,Letter ,Coronavirus disease 2019 (COVID-19) ,Original ,COVID-19 ,Interstitial pneumonia ,Lung ultrasound ,SARS-CoV-2 ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Internal medicine ,medicine ,Humans ,Lung ,Aged ,Ultrasonography ,business.industry ,030208 emergency & critical care medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Pneumonia ,Early Diagnosis ,030228 respiratory system ,Respiratory failure ,Observational study ,business - Abstract
Purpose To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history. Methods This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed. Results We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23–91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55–91.65%) that was higher in the mild phenotype (94.4%; CI 90.0–97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6–6.7, p
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- 2021
4. Azure Lodging, Inc.: A Case Study on Capital Budgeting with Capital Rationing in a Service Industry Context
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James W. Hesford, Michael Burkert, Michael J. Turner, and Thomas G. Calderon
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Capital budgeting ,Finance ,business.industry ,Accounting ,Capital (economics) ,Management accounting ,Rationing ,Context (language use) ,Cash flow ,Business ,Investment (macroeconomics) ,Net present value ,Education - Abstract
This case illustrates capital budgeting in a service industry context. Three features should make this case attractive to instructors. First, the firm's rationing of capital means that students must select one investment among competing investment alternatives. Second, the project involves renovation of an existing hotel. Most cases analyze a business expansion by estimating the net present value of a single series of cash flows (i.e., either future cash flows occur or do not occur). In this case, students model cash flows if the project is accepted, comparing those cash flows to a model of cash flows if the hotel continues without renovation. Third, we introduce Monte Carlo analysis, which is an advanced technique for assessing uncertainty. The extensive data students use in this case are from an actual hotel chain's project database. The case has been used in undergraduate and graduate managerial accounting classes. Data Availability: Available as downloadable supplemental material files.
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- 2021
5. Hemoglobin and Clinical Outcomes in the Vericiguat Global Study in Patients With Heart Failure and Reduced Ejection Fraction (VICTORIA)
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Javed Butler, Adrian F. Hernandez, Paul W. Armstrong, Justin A. Ezekowitz, Piotr Ponikowski, Cynthia M. Westerhout, Vojtěch Melenovský, Burkert Pieske, Ciaran McMullan, Yinggan Zheng, Adriaan A. Voors, Jorge Escobedo, Christopher DeFilippi, Lothar Roessig, Carolyn S.P. Lam, Christopher M. O'Connor, Alain Cohen-Solal, leboeuf, Christophe, University of Alberta, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institute of Clinical and Experimental Medicine [Prague, Czech Republic] (ICEM), Mexican Social Security Institute [Mexico City] (M2SI), University of Mississippi Medical Center (UMMC), Duke University Medical Center, Duke-National University of Singapore Graduate Medical School, Inova Heart and Vascular Institute [Falls Church, VA, USA] (IHVI), Berlin Institute of Health (BIH), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Wrocław Medical University, University of Groningen [Groningen], Merck & Co., Inc. [Kenilworth, NJ, États-Unis], Bayer AG [Wuppertal, Germany], and Cardiovascular Centre (CVC)
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Male ,medicine.medical_specialty ,Anemia ,vericiguat ,heart failure ,World Health Organization ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,hemoglobins ,Aged ,Ejection fraction ,business.industry ,Stroke Volume ,medicine.disease ,anemia ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Treatment Outcome ,Heart failure ,Cardiology ,Vericiguat ,Female ,Hemoglobin ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: In the VICTORIA trial (Vericiguat Global Study in Patients with Heart Failure with Reduced Ejection Fraction), anemia occurred more often in patients treated with vericiguat (7.6%) than with placebo (5.7%). We explored the association between vericiguat, randomization hemoglobin, development of anemia, and whether the benefit of vericiguat related to baseline hemoglobin. Methods: Anemia was defined as hemoglobin Results: At baseline, 1719 (35.7%) patients had World Health Organization anemia; median hemoglobin was 13.4 g/L (25th, 75th percentile: 12.1, 14.7 g/dL). At 16 weeks from randomization, 1643 patients had World Health Organization anemia (284 new for vericiguat and 219 for placebo), which occurred more often with vericiguat than placebo ( P Conclusions: Anemia was common at randomization and lower hemoglobin was associated with a greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor was it related to the treatment benefit of vericiguat. Registration: URL: https://www.clinicaltrials.gov : Unique identifier: NCT02861534.
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- 2021
6. NT‐proBNP as a marker for atrial fibrillation and heart failure in four observational outpatient trials
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Stephan B. Felix, Lutz Binder, Kathleen Nolte, Christoph Herrmann-Lingen, Rolf Wachter, Ulrich Laufs, Helge Haarmann, Stefan Gross, Frank T. Edelmann, Gerd Hasenfuß, Christian Becker, Marcus Dörr, Daniela Husser, Meinhard Mende, Martin Scherer, Stefanie Maria Werhahn, Samira Zeynalova, Astrid Petersmann, Nikolaos Dagres, Markus W. Löffler, and Burkert Pieske
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Male ,medicine.medical_specialty ,medicine.drug_class ,Population ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Natriuretic Peptide, Brain ,Outpatients ,medicine ,Natriuretic peptide ,Diseases of the circulatory (Cardiovascular) system ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,education ,Aged ,Heart Failure ,education.field_of_study ,business.industry ,Area under the curve ,Atrial fibrillation ,Original Articles ,Biomarker ,Middle Aged ,medicine.disease ,Brain natriuretic peptide ,Peptide Fragments ,Population‐based cohort studies ,Heart failure ,RC666-701 ,Cardiology ,Original Article ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). It is known that AF impairs the diagnostic accuracy of NT‐proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT‐proBNP for HF and AF in stable outpatients with cardiovascular risk factors. Methods and results Data were obtained from the DIAST‐CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population‐based cohorts using the same inclusion/exclusion criteria: LIFE‐Adult (n = 2869), SHIP (n = 2013), and SHIP‐TREND (n = 2408). Serum levels of NT‐proBNP were taken once at baseline. The DIAST‐CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT‐proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT‐proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver‐operating characteristic curves of NT‐proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79–0.88]) and for HF with EF 50% was significantly lower (0.61 [0.56–0.65]) than for AF (P = 0.001). During follow‐up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT‐proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75–0.83]) than of newly diagnosed HF (0.59 [0.55–0.63]; P 50% is very limited.
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- 2021
7. Insiders Dissected: New Foundations and a Systematisation of the Research on Insiders
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Christian Burkert, Hannes Federrath, and Ephraim Zimmer
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Computer Networks and Communications ,business.industry ,Internet privacy ,Insider threat ,New Foundations ,Computer Science Applications ,Insider ,Identification (information) ,Hardware and Architecture ,Taxonomy (general) ,Key (cryptography) ,Business ,Safety Research ,Software ,Information Systems - Abstract
The insider threat is often cited as one of the most challenging threats for security practitioners. Even though this topic is receiving considerable attention, two main problems remain unsolved. First, research on insider threats is focusing on many different insiders without being able to actually identify and consistently entitle the key aspects of the insiders. As a result, this research can neither be identified by practitioners as being relevant for their real-world insider problems, nor can it be compared with other research targeting the same insider aspects. Second, a clear understanding of insiders is vital for analysing, which insider properties are responsible for the peculiarity of insider threats . In this article, a systematic approach to dissect the defining aspects of insiders is proposed, which includes specific allocatable insider characteristics. Additionally, the insider characteristics are extended toward insider types, which establish universal and unambiguous names for different insiders and which are related with each other to form a new and simple insider taxonomy . The new foundations on insiders allow the comparison of different insider research in a structured manner. Furthermore, the new approach facilitates the identification of specific features of insider threats in future work.
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- 2021
8. NR3C2 genotype is associated with response to spironolactone in diastolic heart failure patients from the Aldo‐DHF trial
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Leanne Dumeny, Frank Edelmann, Julio D. Duarte, Orly Vardeny, Larisa H. Cavallari, and Burkert Pieske
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Heart Failure, Diastolic ,medicine.medical_specialty ,Aldosterone ,Genotype ,business.industry ,Diastolic heart failure ,Diastole ,Spironolactone ,medicine.disease ,Placebo ,Gastroenterology ,Article ,chemistry.chemical_compound ,Receptors, Mineralocorticoid ,Treatment Outcome ,Blood pressure ,Mineralocorticoid receptor ,chemistry ,Internal medicine ,Heart failure ,Humans ,Medicine ,Pharmacology (medical) ,business - Abstract
STUDY OBJECTIVE This study aimed to determine if variants in NR3C2, which codes the target protein of spironolactone, or CYP11B2, which is involved in aldosterone synthesis, were associated with spironolactone response, focused on the primary end point of diastolic function (E/e'), in Aldosterone Receptor Blockade in Diastolic Heart Failure (Aldo-DHF) participants. DESIGN Post-hoc genetic analysis. DATA SOURCE Data and samples were derived from the multi-center, randomized, double-blind, placebo-controlled Aldo-DHF trial. PATIENTS Aldo-DHF participants treated with spironolactone (n = 184) or placebo (n = 178) were included. INTERVENTION Participants were genotyped for NR3C2 rs5522, NR3C2 rs2070951 and CYP11B2 rs1799998 via pyrosequencing. MEASUREMENTS In the placebo and spironolactone arms, separate multivariable linear regression analyses were performed for change in E/e' with each single nucleotide polymorphism (SNP), adjusted for age, sex, and baseline E/e'. To discern potential mechanisms of a genotype effect, associated SNPs were further examined for their association with change in blood pressure, circulating procollagen type III N-terminal peptide (PIIINP), and left atrial area. MAIN RESULTS Carriers of the rs5522 G allele in the placebo arm had a greater increase in E/e' over the 12-month course of the trial compared to noncarriers (β = 1.10; 95% confidence interval [CI]: 0.05-2.16; p = 0.04). No corresponding E/e' worsening by rs5522 genotype was observed in the spironolactone arm. None of the other genotypes were associated with change in E/e'. Compared to noncarriers, rs5522 G carriers also had a greater increase in left atrial area with placebo (β = 0.83; 95% CI: 0.17-1.48; p = 0.01) and a greater reduction in diastolic blood pressure with spironolactone (β = -3.56; 95% CI: -6.73 to -0.39; p = 0.03). Serum PIIINP levels were similar across rs5522 genotypes. CONCLUSIONS Our results suggest that spironolactone attenuates progression of diastolic dysfunction associated with the NR3C2 rs5522 G allele. Validation of our findings is needed.
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- 2021
9. Clinical Outcome Predictions for the VerICiguaT Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) Trial
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Adrian F. Hernandez, Nancy K. Sweitzer, Javed Butler, Hillary Mulder, Arend Mosterd, Piotr Ponikowski, Adriaan A. Voors, Justin A. Ezekowitz, Robert J. Mentz, Kevin J. Anstrom, Paul W. Armstrong, Michele Senni, Burkert Pieske, Christopher M. O'Connor, Carolyn S.P. Lam, and Cardiovascular Centre (CVC)
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medicine.medical_specialty ,education.field_of_study ,Ejection fraction ,business.industry ,Proportional hazards model ,Population ,Heart failure with reduced ejection fraction ,outcomes ,predictive models ,medicine.disease ,Clinical trial ,Internal medicine ,Heart failure ,Cohort ,Clinical endpoint ,Cardiology ,Medicine ,prognosis ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
Background: The prediction of outcomes in patients with heart failure (HF) may inform prognosis, clinical decisions regarding treatment selection, and new trial planning. The VerICiguaT Global Study in Subjects With Heart Failure With Reduced Ejection Fraction included high-risk patients with HF with reduced ejection fraction and a recent worsening HF event. The study participants had a high event rate despite the use of contemporary guideline-based therapies. To provide generalizable predictive data for a broad population with a recent worsening HF event, we focused on risk prognostication in the placebo group.Methods and Results: Data from 2524 participants randomized to placebo with chronic HF (New York Heart Association functional class II–IV) and an ejection fraction of less than 45% were studied and backward variable selection was used to create Cox proportional hazards models for clinical end points, selecting from 66 candidate predictors. Final model results were produced, accounting for missing data, and nonlinearities. Optimism-corrected c-indices were calculated using 200 bootstrap samples. Over a median follow-up of 10.4 months, the primary outcome of HF hospitalization or cardiovascular death occurred in 972 patients (38.5%). Independent predictors of increased risk for the primary end point included HF characteristics (longer HF duration and worse New York Heart Association functional class), medical history (prior myocardial infarction), and laboratory values (higher N-terminal pro-hormone B-type natriuretic peptide, bilirubin, urate; lower chloride and albumin). Optimism-corrected c-indices were 0.68 for the HF hospitalization/cardiovascular death model, 0.68 for HF hospitalization/all-cause death, 0.72 for cardiovascular death, and 0.73 for all-cause death.Conclusions: Predictive models developed in a large diverse clinical trial with comprehensive clinical and laboratory baseline data—including novel measures—performed well in high-risk patients with HF who were receiving excellent guideline-based clinical care.Clinical Trial Registration: Clinicaltrials.gov identifier, NCT02861534.Lay Summary: Patients with heart failure may benefit from tools that help clinicians to better understand a patient's risk for future events like hospitalization. Relatively few risk models have been created after the worsening of heart failure in a contemporary cohort. We provide insights on the risk factors for clinical events from a recent, large, global trial of patients with worsening heart failure to help clinicians better understand and communicate prognosis and select treatment options.
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- 2021
10. Integrating High-Sensitivity Troponin T and Sacubitril/Valsartan Treatment in HFpEF
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Dirk J. van Veldhuisen, Michael R. Zile, Jean L. Rouleau, Michele Senni, Jiankang Liu, Burkert Pieske, Marc A. Pfeffer, Milton Packer, Carolyn S.P. Lam, Margaret F. Prescott, Aldo P. Maggioni, Brian Claggett, Martin Lefkowitz, Pardeep S. Jhund, John J.V. McMurray, Faiez Zannad, Mauro Gori, Scott D. Solomon, Victor Shi, and Cardiovascular Centre (CVC)
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medicine.medical_specialty ,Randomization ,PREDICTION ,medicine.drug_class ,KEY WORDS HFpEF ,GUIDELINES ,DIAGNOSIS ,valsartan ,Sacubitril ,Internal medicine ,medicine ,Natriuretic peptide ,sacubitril ,ELEVATION ,CARDIAC TROPONIN ,Ejection fraction ,business.industry ,musculoskeletal system ,High Sensitivity Troponin T ,medicine.disease ,SPIRONOLACTONE ,PROGNOSTIC VALUE ,PRESERVED EJECTION FRACTION ,Valsartan ,BRAIN NATRIURETIC PEPTIDE ,Heart failure ,high-sensitivity troponin ,Cardiology ,HEART-FAILURE ,Cardiology and Cardiovascular Medicine ,business ,Sacubitril, Valsartan ,medicine.drug - Abstract
OBJECTIVES This study examined the relationship among high-sensitivity troponin-T (hs-TnT), outcomes, and treatment with sacubitril/valsartan in patients with heart failure (HF) and preserved ejection fraction (HFpEF). BACKGROUND hs-TnT is a marker of myocardial injury in HF. METHODS The PARAGON-HF trial randomized 4,796 patients with HFpEF to sacubitril/valsartan or valsartan. We compared the risk of the composite outcome of cardiovascular death (CVD) and total HF hospitalization (HHF) according to hs-TnT. We also assessed the effect of allocated treatment on hs-TnT. RESULTS hs-TnT was available in 1,141 patients (24%) at run-in (median value: 17 ng/L) and 1,260 (26%) at randomization, with 58.3% having hs-TnT >14 ng/L (upper limit of normal). During a median follow-up of 34 months, there were 393 outcome events (82 CVD, 311 HHF). Adjusting for demographics, comorbidities, left ventricular ejection fraction (LVEF), and N-terminal pro B-type natriuretic peptide (NT-proBNP), log-hs-TnT at randomization was an independent predictor of the composite outcome (HR: 1.38; 95% CI: 1.19-1.59; P < 0.001). Compared with valsartan, sacubitril/valsartan significantly reduced hs-TnT by 9% at week 16 (P < 0.001). Patients whose hs-TnT decreased from randomization to 16 weeks to at or below the median value of 17 ng/L subsequently had a lower risk of CVD/HHF compared with those with persistently elevated hs-TnT (P = 0.046). Patients with higher baseline hs-TnT (>17 ng/L) appeared to have a greater benefit from sacubitril/valsartan treatment when accounting for other potential effect modifiers (P interaction = 0.07). CONCLUSIONS Higher baseline hs-TnT was associated with increased risk of CVD/HHF, whereas hs-TnT decrease at 16 weeks led to lower subsequent risk of CVD/HHF compared with those who had persistently elevated values. Sacubitril/valsartan significantly reduced hs-TnT compared with valsartan. hs-TnT may be helpful in identifying patients with HFpEF who are more likely to benefit from sacubitril/valsartan. (J Am Coll Cardiol HF 2021;9:627-635) (c) 2021 by the American College of Cardiology Foundation.
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- 2021
11. Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction
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Christopher M. O'Connor, Lothar Roessig, Justin A. Ezekowitz, Adrian F. Hernandez, Carolyn S.P. Lam, Eugene B. Reyes, Joerg Koglin, Hillary Mulder, Johan Lassus, Martin R. Cowie, Javed Butler, Piotr Ponikowski, Paul W. Armstrong, Kevin J. Anstrom, Adriaan A. Voors, Burkert Pieske, Cardiovascular Centre (CVC), and HUS Heart and Lung Center
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Male ,Cardiac & Cardiovascular Systems ,VICTORIA Study Group ,030204 cardiovascular system & hematology ,Kidney ,chemistry.chemical_compound ,0302 clinical medicine ,Medicine ,Estimated glomerular filtration rate ,1102 Cardiorespiratory Medicine and Haematology ,Research Articles ,Victoria Trial ,Ejection fraction ,Hazard ratio ,Heart failure with reduced ejection fraction ,3. Good health ,Treatment Outcome ,ENALAPRIL ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,Research Article ,Glomerular Filtration Rate ,medicine.drug ,medicine.medical_specialty ,Renal function ,Heart failure ,Heterocyclic Compounds, 2-Ring ,03 medical and health sciences ,Internal medicine ,Humans ,Enalapril ,Aged ,Creatinine ,Science & Technology ,business.industry ,Proportional hazards model ,Stroke Volume ,medicine.disease ,Confidence interval ,Pyrimidines ,Cardiovascular System & Hematology ,chemistry ,3121 General medicine, internal medicine and other clinical medicine ,Cardiovascular System & Cardiology ,INHIBITORS ,business - Abstract
Aims Vericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2. We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function. Methods and results In VICTORIA, core laboratory serum creatinine was measured at baseline (n = 4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase ≥0.3 mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m2. During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P = 0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P = 0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11–1.47; P, The left panel shows no differences in the change in creatinine (P = 0.18) between the vericiguat and placebo groups, as evaluated by the interaction between treatment and study visit in the model. The right panel shows a natural cubic spline plot showing that the treatment effect of vericiguat on the primary outcome was similar across the full range of estimated glomerular filtration rate (eGFR) (P = 0.23).
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- 2021
12. Microscopical assessment of explanted allograft heart valves: a limited contribution of histopathology to the pathogenic mechanism of the graft failure in long-term explants
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Vilém Rohn, Mariia Havova, Rudolf Poruban, Roman Gebauer, Václav Chaloupecký, Ondřej Materna, Jan Burkert, Jan Janoušek, Eliška Obešlová, Ondřej Fabián, Jaroslav Špatenka, and Filip Mikuš
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Gynecology ,medicine.medical_specialty ,Graft failure ,business.industry ,Medicine ,Allograft heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Pozadi studie: Kryoprezervovane chlopenni alografty (CAHV) v soucasne době představuji konduity volby vykazujici delsi dobu přežiti v porovnani s jinými typy chlopennich protez. Nicmeně teměř vsichni pacienti v průběhu casu rozvinou casne nebo pozdni selhani alograftu. Přesný mechanismus selhani ci připadna role buněcne nebo humoralni rejekce vsak zůstavaji nejasne. V teto studii jsme se zaměřili na mikroskopickou strukturu CAHV s ohledem na dobu trvani implantace, hodnotili stupeň degenerativnich změn a patrali po znamkach celularni rejekce. Metodika: Do studie bylo prospektivně zařazeno 24 pacientů s CAHV a jeden pacient s chlopennim xenograftem, kteři podstoupili explantaci konduitu v obdobi od listopadu 2017 do května 2020. Zaznamenan byl věk pacientů v době implantace, doba trvani implantace, typ konduitu, hlavni diagnoza přijemce a pocet předchozich implantaci. Mikroskopicka struktura konduitů byla hodnocena pomoci světelne mikroskopie s užitim zakladnich barvicich metod i imunohistochemie. Výsledky: Vsechny konduity byly kompletně avitalni, s useky nekroz, hyalinizace, kalcifikaci, metaplasticke kosti a přerůstani fibroznim pannem. Ve třech připadech byly zastiženy okrsky zanětu rejekcniho charakteru. Tři dalsi pacienti vykazovali v průběhu operace i nasledně mikroskopicky znamky subakutni infekcni endokarditidy. Jak tiže mikroskopických změn, tak i přitomnost rejekcnich infiltratů byly nezavisle na době trvani implantace ci jakekoliv jine klinicke proměnne. Zavěry: Histopatologicke hodnoceni explantovaných konduitů může přispět k objasněni přesneho patogenetickeho mechanismu selhani alograftu. Nicmeně mikroskopicka struktura dlouhodobých explantatů je casto nespecificka a znamky celularni rejekce jsou mirne. Přinosnějsi tak může být mikroskopicke vysetřeni kratkodobých explantatů. © 2021, CKS.
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- 2021
13. How to diagnose heart failure with preserved ejection fraction
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Frank Edelmann, Carolyn S.P. Lam, Adriaan A. Voors, Piotr Ponikowski, Alan G. Fraser, Frank Ruschitzka, Stefan D. Anker, Erwan Donal, Rudolf A. de Boer, Burkert Pieske, Carsten Tschöpe, Petar M. Seferovic, Marco Guazzi, Michael Fu, Walter Paulus, Eike Nagel, Daniel A. Morris, Scott D. Solomon, Gerasimos Filippatos, Patrizio Lancellotti, Elisabeth Pieske-Kraigher, Vojtech Melenovsky, Frans H. Rutten, Ramachandran S. Vasan, Charité Campus Virchow-Klinikum (CVK), German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), University of Groningen [Groningen], Cardiff University, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), University Medical Center Groningen [Groningen] (UMCG), GIGA [Université Liège], Université de Liège, Institute for Clinical and Experimental Medicine (IKEM), University of Wrocław [Poland] (UWr), Harvard Medical School [Boston] (HMS), Boston University School of Medicine (BUSM), Boston University [Boston] (BU), University Medical Center [Utrecht], University Heart Centre Freiburg - Bad Krozingen, Energy Research Centre of the Netherlands (ECN), University of Belgrade [Belgrade], University of Cyprus [Nicosia], Heart Failure Association, Cardiovascular Centre (CVC), University of Zurich, Pieske, Burkert, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and University of Cyprus [Nicosia] (UCY)
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Male ,diagnosis ,VENTRICULAR DIASTOLIC FUNCTION ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,PULMONARY-HYPERTENSION ,0302 clinical medicine ,CAPILLARY WEDGE PRESSURE ,Natriuretic peptide ,echocardiography ,LEFT ATRIAL VOLUME ,030212 general & internal medicine ,AMERICAN SOCIETY ,Ejection fraction ,GUANYLATE-CYCLASE STIMULATOR ,IMPAIRED SYSTOLIC FUNCTION ,Atrial fibrillation ,Middle Aged ,3. Good health ,Echocardiography ,CARDIOVASCULAR MAGNETIC-RESONANCE ,Practice Guidelines as Topic ,cardiovascular system ,Cardiology ,10209 Clinic for Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,Cardiology and Cardiovascular Medicine ,Algorithm ,Algorithms ,medicine.medical_specialty ,Consensus ,medicine.drug_class ,Heart Ventricles ,Clinical Decision-Making ,Diastole ,610 Medicine & health ,Heart failure ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,Internal medicine ,SPECKLE TRACKING ECHOCARDIOGRAPHY ,medicine ,Humans ,cardiovascular diseases ,Pulmonary wedge pressure ,Natriuretic Peptides ,Aged ,Heart Failure, Diastolic ,exercise echocardiography ,business.industry ,biomarkers ,Stroke Volume ,medicine.disease ,NATRIURETIC PEPTIDE LEVELS ,HFpEF ,Heart failure with preserved ejection fraction ,business ,natriuretic peptides - Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), left ventricular (LV) filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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- 2019
14. Traveling Volunteers: A Multi‐Vendor, Multi‐Center Study on Reproducibility and Comparability of <scp>4D</scp> Flow Derived Aortic Hemodynamics in Cardiovascular Magnetic Resonance
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Jeanette Schulz-Menger, Aylin Demir, Jennifer Erley, Jochen Hansmann, Stephanie Wiesemann, Ralf Trauzeddel, Sebastian Kelle, Burkert Pieske, and Sebastian Schmitter
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Adult ,Magnetic Resonance Spectroscopy ,Intraclass correlation ,Population ,4D flow ,Hemodynamics ,hemodynamics ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,magnetic resonance imaging ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,education ,reproducibility ,standardization ,education.field_of_study ,Reproducibility ,Aortic hemodynamics ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Magnetic resonance imaging ,Repeatability ,Confidence interval ,aorta ,business ,Nuclear medicine ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit - Abstract
Background: Implementation of four-dimensional flow magnetic resonance (4D Flow MR) in clinical routine requires awareness of confounders. Purpose: To investigate inter-vendor comparability of 4D Flow MR derived aortic hemodynamic parameters, assess scan-rescan repeatability, and intra- and interobserver reproducibility. Study type: Prospective multicenter study. Population: Fifteen healthy volunteers (age 24.5 ± 5.3 years, 8 females). Field strength/sequence: 3 T, vendor-provided and clinically used 4D Flow MR sequences of each site. Assessment: Forward flow volume, peak velocity, average, and maximum wall shear stress (WSS) were assessed via nine planes (P1-P9) throughout the thoracic aorta by a single observer (AD, 2 years of experience). Inter-vendor comparability as well as scan-rescan, intra- and interobserver reproducibility were examined. Statistical tests: Equivalence was tested setting the 95% confidence interval of intraobserver and scan-rescan difference as the limit of clinical acceptable disagreement. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used for scan-rescan reproducibility and intra- and interobserver agreement. A P-value 0.9: excellent, 0.75-0.9: good). Results: Ten volunteers finished the complete study successfully. 4D flow derived hemodynamic parameters between scanners of three different vendors are not equivalent exceeding the equivalence range. P3-P9 differed significantly between all three scanners for forward flow (59.1 ± 13.1 mL vs. 68.1 ± 12.0 mL vs. 55.4 ± 13.1 mL), maximum WSS (1842.0 ± 190.5 mPa vs. 1969.5 ± 398.7 mPa vs. 1500.6 ± 247.2 mPa), average WSS (1400.0 ± 149.3 mPa vs. 1322.6 ± 211.8 mPa vs. 1142.0 ± 198.5 mPa), and peak velocity between scanners I vs. III (114.7 ± 12.6 cm/s vs. 101.3 ± 15.6 cm/s). Overall, the plane location at the sinotubular junction (P1) presented most inter-vendor stability (forward: 78.5 ± 15.1 mL vs. 80.3 ± 15.4 mL vs. 79.5 ± 19.9 mL [P = 0.368]; peak: 126.4 ± 16.7 cm/s vs. 119.7 ± 13.6 cm/s vs. 111.2 ± 22.6 cm/s [P = 0.097]). Scan-rescan reproducibility and intra- and interobserver variability were good to excellent (ICC ≥ 0.8) with best agreement for forward flow (ICC ≥ 0.98). Data conclusion: The clinical protocol used at three different sites led to differences in hemodynamic parameters assessed by 4D flow. Level of evidence: 2 TECHNICAL EFFICACY STAGE: 2.
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- 2021
15. Fast Strain-Encoded Cardiac Magnetic Resonance for Diagnostic Classification and Risk Stratification of Heart Failure Patients
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Tomas Lapinskas, Sorin Giusca, Burkert Pieske, Andre Florian, Hugo A. Katus, Amit R. Patel, Victoria Zieschang, Grigorios Korosoglou, Henning Steen, Jennifer Erley, Sarah Al-Tabatabaee, Sebastian Kelle, Moritz Montenbruck, and Collin Götze
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medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Myocarditis ,Contrast Media ,Gadolinium ,030204 cardiovascular system & hematology ,Risk Assessment ,Asymptomatic ,030218 nuclear medicine & medical imaging ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Subclinical infection ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,United States ,Heart failure ,Cardiology ,Population study ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The purpose of this study was to compare the ability of fast-strain encoded magnetic resonance (fast-SENC) cardiac magnetic resonance (CMR) to classify and risk stratify all-comer patients with different stages of chronic heart failure (Stages of heart failure A to D) based on American College of Cardiology/American Heart Association guidelines with standard clinical and CMR imaging data.Heart failure is a major cause of morbidity and mortality, resulting in millions of deaths and hospitalizations annually.The study population consisted of 1,169 consecutive patients between September 2017 and February 2019 who underwent CMR for clinical reasons, and 61 healthy volunteers. In addition, clinical follow-up was performed in Stages A and B patients after 1.9 ± 0.4 years. Wall motion score and late gadolinium enhancement score indexes, left ventricular (LV) ejection fraction, and global circumferential and longitudinal strain based on fast-SENC acquisitions, were calculated in all subjects. The percentage of myocardial segments with strain ≤-17% (% normal myocardium) was determined in all subjects.LV ejection fraction, global circumferential and longitudinal strain, and % normal myocardium significantly decreased with increasing heart failure stages (p 0.001 for all by analysis of variance). By multivariable analysis, % normal myocardium remained an independent predictor of heart failure stages, exhibiting closer association than LV ejection fraction (rThe % normal myocardium, determined by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV dysfunction compared with LV ejection fraction and risk stratification of patients with so far asymptomatic heart failure. The identification of such presumably healthy patients at high risk for heart failure-related outcomes may bear important medical implications.
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- 2021
16. 5G - The New Gold Standard?
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Andreas Burkert
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Engineering ,business.industry ,General Earth and Planetary Sciences ,Nanotechnology ,General Medicine ,Gold standard (test) ,business ,General Environmental Science - Published
- 2021
17. Cardiac arrhythmias in patients with COVID-19: Lessons from 2300 telemetric monitoring days on the intensive care unit
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Ulf Landmesser, Tim Guthof, Karl Stangl, Theresa Keller, Sebastian Biewener, Verena Tscholl, Martin Huemer, Stefan Angermair, Philipp Attanasio, Abdul Shokor Parwani, Paul Kamieniarz, Florian Blaschke, Sascha Treskatsch, Holger Müller-Redetzky, Marcel Haug, Burkert Pieske, Daniel Zieckler, Leif-Hendrik Boldt, and Jan Kruse
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Tachycardia ,medicine.medical_specialty ,Defibrillation ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cardioversion ,Ventricular tachycardia ,Article ,law.invention ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine ,Humans ,Intensive care unit ,Sars cov 2 ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,COVID-19 ,Arrhythmias, Cardiac ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Intensive Care Units ,Ventricular fibrillation ,cardiovascular system ,Cardiology ,RNA, Viral ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Telemetric ECG monitoring - Abstract
BACKGROUND: Patients with COVID-19 seem to be prone to the development of arrhythmias. The objective of this trial was to determine the characteristics, clinical significance and therapeutic consequences of these arrhythmias in COVID-19 patients requiring intensive care unit (ICU) treatment. METHODS AND RESULTS: A total of 113 consecutive patients (mean age 64.1 ± 14.3 years, 30 (26.5%) female) with positive PCR testing for SARS-CoV2 as well as radiographically confirmed pulmonary involvement admitted to the ICU from March to May 2020 were included and observed for a cumulative time of 2321 days. Fifty episodes of sustained atrial tachycardias, five episodes of sustained ventricular arrhythmias and thirty bradycardic events were documented. Sustained new onset atrial arrhythmias were associated with hemodynamic deterioration in 13 cases (35.1%). Patients with new onset atrial arrhythmias were older, showed higher levels of Hs-Troponin and NT-proBNP, and a more severe course of disease. The 5 ventricular arrhythmias (two ventricular tachycardias, two episodes of ventricular fibrillation, and one torsade de pointes tachycardia) were observed in 4 patients. All episodes could be terminated by immediate defibrillation/cardioversion. Five bradycardic events were associated with hemodynamic deterioration. Precipitating factors could be identified in 19 of 30 episodes (63.3%), no patient required cardiac pacing. Baseline characteristics were not significantly different between patients with or without bradycardic events. CONCLUSION: Relevant arrhythmias are common in severely ill ICU patients with COVID-19. They are associated with worse courses of disease and require specific treatment. This makes daily close monitoring of telemetric data mandatory in this patient group.
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- 2021
18. 5G - Der neue Goldstandard?
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Andreas Burkert
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Engineering ,business.industry ,Ocean Engineering ,business ,Manufacturing engineering - Published
- 2021
19. COVID-19: ambulante oder stationäre Betreuung? – Risikoscore zur prospektiven Differenzierung leichter und schwerer Verläufe
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Alexander Dinse-Lambracht, Lynn Peters, Sanne Burkert, Johannes Peifer, and Beate Grüner
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Gynecology ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Emergency Medicine ,medicine ,030212 general & internal medicine ,Severe course ,business - Abstract
ZusammenfassungWährend die Zahl an Personen, die sich mit SARS-CoV-2 infizierte, über eine lange Zeit stieg, nahmen die Behandlungskapazitäten in den Krankenhäusern entsprechend ab. Um Patienten nicht zu gefährden und gleichzeitig Ressourcen zu schonen, ist eine frühzeitige Differenzierung zwischen prognostisch leichten und schweren Verläufen erforderlich. Zur Identifikation von COVID-19-Fällen mit stationärem Behandlungsbedarf wurde zu Beginn der Pandemie ein COVID-19-Risikoscore basierend auf einer Literaturrecherche und ersten klinischen Erfahrungen erstellt und im Rahmen einer retrospektiven Kohortenstudie mit 155 Patienten validiert. Aufgrund des hohen prädiktiven Wertes und der Diskriminierungsfähigkeit kann der etablierte COVID-19-Risikoscore ein unterstützendes Instrument für klinisch tätige Ärzte an der Sektorengrenze zwischen ambulantem und stationärem Bereich darstellen.
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- 2021
20. 'Efficiency levels over 98 % are essential'
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Andreas Burkert
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Engineering ,business.industry ,General Medicine ,business ,Manufacturing engineering - Published
- 2021
21. 'Wirkungsgrade von über 98 % sind essenziell'
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Andreas Burkert
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Engineering ,business.industry ,Ocean Engineering ,business ,Automotive engineering - Published
- 2021
22. Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism
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Burkert Pieske, Karl Stangl, Charlotta F. Pagel, Matthias Ebner, Veli-Pekka Harjola, Carmen Sentler, Stavros Konstantinides, Gerd Hasenfuß, Mareike Lankeit, Markus H. Lerchbaumer, Héctor Bueno, Ministerio de Economía y Competitividad (España), Fundación ProCNIC, German Federal Ministry of Education and Research, HUS Emergency Medicine and Services, University of Helsinki, and Helsinki University Hospital Area
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medicine.medical_specialty ,Adverse outcomes ,Venous lactate ,030204 cardiovascular system & hematology ,GUIDELINES ,DIAGNOSIS ,03 medical and health sciences ,THROMBOEMBOLISM ,0302 clinical medicine ,Internal medicine ,MANAGEMENT ,Internal Medicine ,medicine ,Humans ,In patient ,Lactic Acid ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Risk stratification ,RISK ,Venipuncture ,business.industry ,Biomarker ,ARTERIAL ,Prognosis ,medicine.disease ,EUROPEAN-SOCIETY ,Hospitals ,3. Good health ,Peripheral ,Pulmonary embolism ,3121 General medicine, internal medicine and other clinical medicine ,Cardiology ,Biomarker (medicine) ,Pulmonary Embolism ,business ,TASK-FORCE - Abstract
Arterial lactate is an established risk marker in patients with pulmonary embolism (PE). However, its clinical applicability is limited by the need of an arterial puncture. In contrast, venous lactate can easily be measured from blood samples obtained via routine peripheral venepuncture. We investigated the prognostic value of venous lactate with regard to in-hospital adverse outcomes and mortality in 419 consecutive PE patients enrolled in a single-center registry between 09/2008 and 09/2017. An optimised venous lactate cut-off value of 3.3 mmol/l predicted both, in-hospital adverse outcome (OR 11.0 [95% CI 4.6-26.3]) and all-cause mortality (OR 3.8 [95%CI 1.3-11.3]). The established cut-off value for arterial lactate (2.0 mmol/l) and the upper limit of normal for venous lactate (2.3 mmol/l) had lower prognostic value for adverse outcomes (OR 3.6 [95% CI 1.5-8.7] and 5.7 [95% CI 2.4-13.6], respectively) and did not predict mortality. If added to the 2019 European Society of Cardiology (ESC) algorithm, venous lactate
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- 2021
23. Proteomic and Mechanistic Analysis of Spironolactone in Patients at Risk for HF
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Pierpaolo Pellicori, Blerim Mujaj, Stephane Heymans, Fozia Z Ahmed, N. Girerd, Ping Wang, Arantxa González, Hans-Peter Brunner-La-Rocca, Javier Díez, Franco Cosmi, Frank T. Edelmann, Mark R. Hazebroek, João Pedro Ferreira, Joe Cuthbert, Andrew L. Clark, Johannes Petutschnigg, Mamas A. Mamas, Roberto Latini, Job A J Verdonschot, John G.F. Cleland, Beatrice Mariottoni, Patrick Rossignol, Javed Khan, Jan A. Staessen, Burkert Pieske, Faiez Zannad, Anne Pizard, Stéphanie Grojean, Timothy Collier, Philippe Rouet, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], London School of Hygiene and Tropical Medicine (LSHTM), University of Manchester [Manchester], University of Hull [United Kingdom], Cortona Hospital, Universidad de Navarra [Pamplona] (UNAV), German Heart Institute Berlin, University of Glasgow, Mario Negri Institute, Center for Human Genetics, University of Leuven School of Medicine, SCHOOL of MEDICINE [Louvain], Université Catholique de Louvain = Catholic University of Louvain (UCL)-Université Catholique de Louvain = Catholic University of Louvain (UCL), Centre d'anthropologie et de génomique de Toulouse (CAGT), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS), Author Disclosures HOMAGE was funded by a grant from the European Union 7th Framework Programme for Research and Technological Development (HEALTH-F7-305507 HOMAGE (EU FP7 305507 http://www.homage-hf.eu). Drs. Ferreira, Rossignol, Girerd, and Zannad are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d’Avenir' program (reference: ANR-15-RHUS-0004), the French PIA project 'Lorraine Université d’Excellence' (reference: ANR-15-IDEX-04-LUE), Contrat de Plan Etat Lorraine IT2MP, and FEDER Lorraine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE,Isite LUE(2015), European Project: 305507,EC:FP7:HEALTH,FP7-HEALTH-2012-INNOVATION-1,HOMAGE(2013), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), DE CARVALHO, Philippe, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, Heart OMics in AGEing - HOMAGE - - EC:FP7:HEALTH2013-02-01 - 2019-01-31 - 305507 - VALID, RS: Carim - H02 Cardiomyopathy, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and MUMC+: MA Med Staf Artsass Cardiologie (9)
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Male ,Proteomics ,[SDV]Life Sciences [q-bio] ,Adipokine ,Inflammation ,030204 cardiovascular system & hematology ,Pharmacology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Mineralocorticoid receptor ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Fibrosis ,Renin–angiotensin system ,Natriuretic Peptide, Brain ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Mineralocorticoid Receptor Antagonists ,Heart Failure ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,fibrosis ,spironolactone ,HEART-FAILURE INSIGHTS ,medicine.disease ,Brain natriuretic peptide ,3. Good health ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,CARDIAC MATRIX BIOMARKERS ,[SDV] Life Sciences [q-bio] ,renin-angiotensin-aldosterone system ,chemistry ,MYOCARDIAL-INFARCTION ,inflammation ,Heart failure ,Spironolactone ,SURVIVAL ,EPLERENONE ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,heart failure prevention ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
OBJECTIVES This study sought to further understand the mechanisms underlying effect of spironolactone and assessed its impact on multiple plasma protein biomarkers and their respective underlying biologic pathways.BACKGROUND In addition to their beneficial effects in established heart failure (HF), mineralocorticoid receptor antagonists may act upstream on mechanisms, preventing incident HF. In people at risk for developing HF, the HOMAGE (Heart OMics in AGEing) trial showed that spironolactone treatment could provide antifibrotic and antiremodeling effects, potentially slowing the progression to HF.METHODS Baseline, 1-month, and 9-month (or last visit) plasma samples of HOMAGE participants were measured for protein biomarkers (n = 276) by using Olink Proseek-Multiplex cardiovascular and inflammation panels (Olink, Uppsala, Sweden). The effect of spironolactone on biomarkers was assessed by analysis of covariance and explored by knowledgebased network analysis. RESULTS A total of 527 participants were enrolled; 265 were randomized to spironolactone (25 to 50 mg/day) and 262 to standard care ("control"). The median (interquartile range) age was 73 years (69 to 79 years), and 26% were female. Spironolactone reduced biomarkers of collagen metabolism (e.g., COL1A1, MMP-2); brain natriuretic peptide; and biomarkers related to metabolic processes (e.g., PAPPA), inflammation, and thrombosis (e.g., IL17A, VEGF, and urokinase). Spironolactone increased biomarkers that reflect the blockade of the mineralocorticoid receptor (e.g., renin) and increased the levels of adipokines involved in the anti-inflammatory response (e.g., RARRES2) and biomarkers of hemostasis maintenance (e.g., tPA, UPAR), myelosuppressive activity (e.g., CCL16), insulin suppression (e.g., RETN), and inflammatory regulation (e.g., IL-12B).CONCLUSIONS Proteomic analyses suggest that spironolactone exerts pleiotropic effects including reduction in fibrosis, inflammation, thrombosis, congestion, and vascular function improvement, all of which may mediate cardiovascular protective effects, potentially slowing progression toward heart failure. (HOMAGE [Bioprofiling Response to Mineralocorticoid Receptor Antagonists for the Prevention of Heart Failure]; NCT02556450) (C) 2021 by the American College of Cardiology Foundation.
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- 2021
24. Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial
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Holger Thiele, Alper Öner, Peter Boekstegers, Ingo Voigt, Ulrich Laufs, Malte Kelm, Georg Fuernau, Maria Rubini Gimenez, Hans-Josef Feistritzer, Peter Abel, Christian W. Hamm, Mariuca Vasa-Nicotera, Carsten Tschöpe, Markus Ferrari, Tobias Graf, Carsten Skurk, Christian Karagiannidis, Benjamin Schempf, P. Christian Schulze, Tim Seidler, Tienush Rassaf, Michael R. Preusch, Helge Möllmann, Stephan B. Felix, Ralf Lehmann, Alexander Bufe, Harald Lapp, Christian Jung, Christoph Kadel, Ibrahim Akin, Ralf Muellenbach, Ulf Landmesser, Marcus Hennersdorf, Philipp Lauten, Janine Pöss, Ecls-Shock Investigators, Marko Noc, Hans-Bernd Hopf, Stephan Baldus, Peter Nordbeck, Dirk Westermann, Tomaz Goslar, Ilka Oerlecke, Axel Linke, Steffen Desch, Taoufik Ouarrak, Alexander Lauten, Peter Clemmensen, Felix Meincke, Michael Böhm, Holger Nef, Karsten Lenk, A A Mahabadi, Jutta Franz, Britta Goldmann, Steffen Schneider, Tobias Wengenmayer, Lars S Maier, Bernhard Schieffer, Alexander Kersten, Anne Freund, Thomas J. Dengler, Uwe Zeymer, Stefan Baumanns, Suzanne de Waha-Thiele, Stefan John, Daniel Sedding, Wolfgang Rottbauer, Leonhard Bruch, Melchior Seyfarth, and Burkert Pieske
- Subjects
endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Shock, Cardiogenic ,Medizin ,030204 cardiovascular system & hematology ,Revascularization ,law.invention ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Fibrinolytic Agents ,Randomized controlled trial ,law ,Internal medicine ,Myocardial Revascularization ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,business.industry ,Cardiogenic shock ,Prognosis ,medicine.disease ,3. Good health ,Clinical trial ,Sample Size ,Shock (circulatory) ,Quality of Life ,Cardiology ,Myocardial infarction complications ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials. Therefore, a prospective randomized adequately powered clinical trial is warranted. Study Design The ECLS-SHOCK trial is a 420-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare whether treatment with ECLS in addition to early revascularization with percutaneous coronary intervention or alternatively coronary artery bypass grafting and optimal medical treatment is beneficial in comparison to no-ECLS in patients with severe infarct-related cardiogenic shock. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of ECLS-SHOCK is 30-day mortality. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, a longer follow-up at 6 and 12 months will be performed including quality of life assessment. Safety endpoints include peripheral ischemic vascular complications, bleeding and stroke. Conclusions The ECLS-SHOCK trial will address essential questions of efficacy and safety of ECLS in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock.
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- 2021
25. Acquired megaesophagus in a dog – case report
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Carina Burkert da Silva, Arthur de Lima Espinosa, Thaís Cozza dos Santos, Bruna Dias Fagundes, Eduarda Aléxia Nunes Louzada Dias Cavalcanti, Guilherme Albuquerque de Oliveira Cavalcanti, and Mariana C. H. Rondelli
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medicine.medical_specialty ,business.industry ,medicine ,Megaesophagus ,General Materials Science ,Radiology ,medicine.disease ,business - Abstract
Acquired megaesophagus is an uncommon cause of regurgitation in dogs. Diagnosis is confirmed by simple or contrast radiographs, endoscopy, tomography, scintigraphy, or magnetic resonance imaging. Esophagography with barium sulphate contrast is the most commonly used method, however, it may be inconclusive if dilation marking does not occur. This paper reports the case of a 9-year-old female dog, with a history of regurgitation over six months, simple and contrast radiographic exams showing no evidence of megaesophagus. The esophagography exam was repeated with the addition of barium contrast mixed with commercial dry pet food, which verified esophageal dilatation and confirmed megaesophagus. Although this technique is not widely used, it is an effective alternative method for diagnosis of canine megaesophagus, particularly when other radiographic approaches are inconclusive.
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- 2021
26. Induction and exacerbation of subacute cutaneous lupus erythematosus following mRNA‐based or adenoviral vector‐based SARS‐CoV‐2 vaccination
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A. Kreuter, A.-L. Michalowitz, S.-N. Burmann, F. Oellig, M. J. Licciardi-Fernandez, and B. Burkert
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Messenger RNA ,Exacerbation ,biology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Dermatology ,medicine.disease ,law.invention ,Viral vector ,Vaccination ,Subacute cutaneous lupus erythematosus ,law ,Correspondence ,Immunology ,Recombinant DNA ,biology.protein ,Medicine ,Antibody ,business ,Letter to the Editor - Abstract
Evidence is accumulating that COVID‐19 vaccines might induce or exacerbate autoimmune rheumatic diseases. The currently available COVID‐19 vaccines include mRNA and recombinant adenoviral vector vaccines, both encoding SARS‐CoV‐2 spike protein production as the primary target for neutralizing antibodies. We report a case of subacute cutaneous lupus erythematosus (SCLE) following mRNA vaccination with the Pfizer mRNA vaccine BNT162b2, and summarize the current literature on CLE occurring after COVID‐19 vaccination.
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- 2021
27. The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the heart ‘OMics’ in AGEing (HOMAGE) randomized clinical trial
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Cleland, John, Ferreira, João Pedro, Mariottoni, Beatrice, Pellicori, Pierpaolo, Cuthbert, Joe, Verdonschot, Job, Petutschnigg, Johannes, Ahmed, Fozia, COSMI, FRANCO, Brunner La Rocca, Hans-Peter, Mamas, Mamas, Clark, Andrew, Edelmann, Frank, Pieske, Burkert, Khan, Javed, McDonald, Ken, Rouet, Philippe, Staessen, Jan, Mujaj, Blerim, González, Arantxa, Diez, Javier, Hazebroek, Mark, Heymans, Stephane, Latini, Roberto, Grojean, Stéphanie, Pizard, Anne, Girerd, Nicolas, Rossignol, Patrick, Collier, Tim, Zannad, Faiez, Atar, Dan, Kober, Lars, Dickstein, Kenneth, Lange, Theis, RS: Carim - H02 Cardiomyopathy, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), MUMC+: MA Med Staf Artsass Cardiologie (9), University of Glasgow, Robertson Centre for Biostatistics, University of Glasgow, Institute of Health and Wellbeing, University of Glasgow-Gartnavel General Hospital, Glasgow, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Cortona Hospital, Castle Hill Hospital, University of Hull [United Kingdom], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), German Center for Cardiovascular Research (DZHK), Manchester Academic Health Science Centre (MAHSC), University of Manchester [Manchester], Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Keele University [Keele], University College Dublin [Dublin] (UCD), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Universitäts Klinikum Freiburg, Universidad de Navarra [Pamplona] (UNAV), Institute of Health Carlos III, Instituto de Investigación Sanitaria de Navarra [Pamplona, Spain] (IdiSNA), IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Fondation Force, Research and Consulting Department, EDDH, Centre de Médecine Préventive, and London School of Hygiene and Tropical Medicine (LSHTM)
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Male ,Aging ,Cardiac & Cardiovascular Systems ,Spironolactone ,030204 cardiovascular system & hematology ,Q1 ,Gastroenterology ,chemistry.chemical_compound ,0302 clinical medicine ,Fibrosis ,Clinical endpoint ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,Mineralocorticoid Receptor Antagonists ,Collagen markers ,R735 ,Heart failure prevention ,RC666 ,16. Peace & justice ,3. Good health ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,Procollagen ,Cardiac function curve ,medicine.medical_specialty ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,N-terminal telopeptide ,Clinical Research ,Internal medicine ,medicine ,Humans ,Heart Failure and Cardiomyopathies ,Aged ,Heart Failure ,Science & Technology ,business.industry ,medicine.disease ,R1 ,Peptide Fragments ,Procollagen peptidase ,Blood pressure ,chemistry ,Heart failure ,Cardiovascular System & Cardiology ,ras Proteins ,business ,RA ,Biomarkers - Abstract
Importance: Cardiovascular accumulation of collagen (fibrosis) may contribute to the progression from ventricular dysfunction to heart failure. Galectin-3, a potential marker of pro-fibrotic activity, might identify those at greater risk.\ud Objective: To investigate the effects of spironolactone, according to serum galectin-3 concentration, on serum markers of fibrosis and on cardiac structure and function, in people at increased risk of developing heart failure.\ud Design: Prospective, randomized, open-label, blinded endpoint (PROBE) trial.\ud Setting: Clinical research facilities in ten European hospitals.\ud Participants: People with, or at high-risk of, coronary disease with increased plasma concentrations of B-type natriuretic peptides (BNP or NT-proBNP).\ud Interventions: spironolactone (up to 50 mg/day) or control for up to nine months.\ud Main Outcomes and Measures: The primary outcome was the interaction between baseline serum galectin-3 and change in serum procollagen type-III N-terminal pro-peptide (PIIINP), a by-product of type-III collagen synthesis. Serum procollagen type-I C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), respectively reflecting synthesis and degradation of type-I collagen, were also measured.\ud Results: Of 527 participants, the median age was 73 years and 26% were women. Median follow-up was 267 days. Changes in PIIINP were similar for those assigned to spironolactone and control (mean difference -0.15; 95% confidence interval [CI] -0.44 to 0.15 μg/L; p=0.32) and did not differ when serum galectin-3 was above or below median. Those assigned to spironolactone had greater declines in PICP (mean difference -8.1; -95% CI -11.9 to -4.3 μg/L; p
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- 2020
28. Diagnostic value of cardiovascular magnetic resonance in comparison to endomyocardial biopsy in cardiac amyloidosis: a multi-centre study
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Gloria Tauscher, Sebastian Kelle, Burkert Pieske, Andreas Rolf, Ahmed Elsanhoury, J Vietheer, Ali Yilmaz, Heiko Mahrholdt, Carsten Tschöpe, Zornitsa Shomanova, Grigorios Chatzantonis, and Michael Bietenbeck
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Male ,medicine.medical_specialty ,Immunofixation ,Biopsy ,Cardiomyopathy ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Scintigraphy ,030218 nuclear medicine & medical imaging ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,EMB ,medicine ,Humans ,cardiovascular diseases ,CMR ,Aged ,Aged, 80 and over ,Original Paper ,CA ,medicine.diagnostic_test ,biology ,business.industry ,Amyloidosis ,Myocardium ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Transthyretin ,Cardiac amyloidosis ,ROC Curve ,Heart failure ,Cardiology ,biology.protein ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Abstract
Background Cardiac amyloidosis (CA) is an infiltrative disease characterised by accumulation of amyloid deposits in the extracellular space of the myocardium—comprising transthyretin (ATTR) and light chain (AL) amyloidosis as the most frequent subtypes. Histopathological proof of amyloid deposits by endomyocardial biopsy (EMB) is the gold standard for diagnosis of CA. Cardiovascular magnetic resonance (CMR) allows non-invasive workup of suspected CA. We conducted a multi-centre study to assess the diagnostic value of CMR in comparison to EMB for the diagnosis of CA. Methods We studied N = 160 patients characterised by symptoms of heart failure and presence of left ventricular (LV) hypertrophy of unknown origin who presented to specialised cardiomyopathy centres in Germany and underwent further diagnostic workup by both CMR and EMB. If CA was diagnosed, additional subtyping based on EMB specimens and monoclonal protein studies in serum was performed. The CMR protocol comprised cine- and late-gadolinium-enhancement (LGE)-imaging as well as native and post-contrast T1-mapping (in a subgroup)—allowing to measure extracellular volume fraction (ECV) of the myocardium. Results An EMB-based diagnosis of CA was made in N = 120 patients (CA group) whereas N = 40 patients demonstrated other diagnoses (CONTROL group). In the CA group, N = 114 (95%) patients showed a characteristic pattern of LGE indicative of CA. In the CONTROL group, only 1/40 (2%) patient showed a “false-positive” LGE pattern suggestive of CA. In the CA group, there was no patient with elevated T1-/ECV-values without a characteristic pattern of LGE indicative of CA. LGE-CMR showed a sensitivity of 95% and a specificity of 98% for the diagnosis of CA. The combination of a characteristic LGE pattern indicating CA with unremarkable monoclonal protein studies resulted in the diagnosis of ATTR-CA (confirmed by EMB) with a specificity of 98% [95%-confidence interval (CI) 92–100%] and a positive predictive value (PPV) of 99% (95%-CI 92–100%), respectively. The EMB-associated risk of complications was 3.13% in this study—without any detrimental or persistent complications. Conclusion Non-invasive CMR shows an excellent diagnostic accuracy and yield regarding CA. When combined with monoclonal protein studies, CMR can differentiate ATTR from AL with high accuracy and predictive value. However, invasive EMB remains a safe invasive gold-standard and allows to differentiate CA from other cardiomyopathies that can also cause LV hypertrophy.
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- 2020
29. Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial
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Raphael Twerenbold, Robert Zweiker, Albrecht Schmidt, Christian Mueller, Nicole Gilgen, Georg Stachel, Ismet Oenal, Tudor C. Poerner, Bernward Lauer, Florian Krackhardt, Sylvia Otto, Alexander Wolf, Michael Kühne, Sven Möbius-Winkler, Yvonne P. Clever, Philipp Haager, Peter Ammann, Peter Rickenbacher, Ahmed Farah, Felix Mahfoud, Jochen Wöhrle, Dominik Buckert, Andreas Hoffmann, Ephraim B. Winzer, Alexandra Roettgen, Stefan Toggweiler, Frank Hölschermann, Andrea Harder-Allgoewer, Paul Erne, Dirk von Lewinski, Robert Höllriegel, Christian Butter, Hans Rickli, Andreas Wagner, Bjoern Plicht, Christian Sticherling, Rima Paliskyte, Leonhard Bruch, Frank-Peter Stephan, Lucas Joerg, Lukas Trachsel, Florian Riede, Bastian Wein, Norman Mangner, Michael J. Zellweger, Matthias Schreiber, Gregor Fahrni, Sebastian Ewen, Marc-Alexander Ohlow, Sinisa Markovic, Berthold Struck, Karsten Lenk, Marco E. G. V. Cattaneo, Stephan Schirmer, Margarete Baumgartner, Hans Roelli, Franziska Rohner, Florim Cuculi, Grit Tambor, Bruno Scheller, Raban Jeger, Axel Linke, Ella Niederl, Burkert Pieske, Dominique Nuessli, Stefan Osswald, Belal Awad, Gudrun Dannberg, Stefan Richter, Michel Noutsias, Christoph Kaiser, Steffen Bohl, Boris Keweloh, Michael Neuss, Mirko Seidel, Micha T. Maeder, Michael Boehm, Corinna Lenz, Bodo Cremers, Ioannis Kapos, Behrouz Kherad, Sabine Perl, Peter Buser, Marcus Franz, Daniel Weilenmann, Ralf Surber, Timo Jerichow, Sebastian Winkler, Olev Luha, and Gregor Leibundgut
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Coronary Artery Disease ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Balloon ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,education ,Aged ,education.field_of_study ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,medicine.disease ,Treatment Outcome ,Cardiovascular Diseases ,Female ,business ,Follow-Up Studies - Abstract
In the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention.In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing.Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance.There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years.Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical.
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- 2020
30. Quantitative evaluation of different high-density 3D mapping modes for atrial and ventricular substrate assessment of cardiac arrhythmias with the HD grid catheter
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Abdul Shokor Parwani, Philipp Lacour, Felix Hohendanner, Florian Blaschke, Leif-Hendrik Boldt, Burkert Pieske, Stefan Kuhlmann, and Sanzio Dimai
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medicine.medical_specialty ,Catheters ,Substrate mapping ,medicine.medical_treatment ,High density ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,3d mapping ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,business.industry ,Atrial fibrillation ,medicine.disease ,Grid ,Ablation ,Catheter ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atrial and ventricular arrhythmias significantly contribute to morbidity and mortality of patients with cardiac disease. Ablation of these arrhythmias has shown to improve clinical outcomes, yet targeted ablation strategies rely on proper mapping capabilities. In the present study, we compare different modes of high-resolution mapping in clinically relevant arrhythmias using HD grid.Using the Advisor™ HD Grid Mapping Catheter in either the standard, the wave (bipolar along spline and bipolar orthogonal) or the wave diagonal setting, low-voltage areas were determined. Low-voltage was defined as local electrograms with an amplitude0.5 mV (bipolar; atria/ventricle) or4 mV (unipolar; ventricle). Ultra high-density mapping in 47 patients with ventricular tachycardia, ventricular premature beats, atrial fibrillation and atrial tachycardia provided reliable information for the understanding of the arrhythmia mechanism resulting in safe ablation procedures. Regions of low voltage were significantly decreased by 14 ± 2% and 31 ± 3% with wave and wave diagonal settings as compared to standard settings, respectively.Substrate mapping and risk stratification relies on proper low voltage discrimination. Even though the Advisor™ HD Grid Mapping Catheter was safely used in all cases, the extent of low voltage areas was mapping-mode dependent.
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- 2020
31. CaMKIIδC Drives Early Adaptive Ca 2+ Change and Late Eccentric Cardiac Hypertrophy
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Stefano Morotti, M. Wallner, Samuel Sossalla, Michael Holzer, Julia Voglhuber, Donald M. Bers, Michael Sacherer, Ingrid Matzer, Stefan Wagner, Natasa Djalinac, Senka Ljubojevic-Holzer, Mahmoud Abdellatif, Simon Sedej, Snjezana Radulovic, Milan Ivanov, Burkert Pieske, Joan Heller Brown, Julie Bossuyt, Brent M. Wood, Anthony W. Herren, and Dirk von Lewinski
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Genetically modified mouse ,medicine.medical_specialty ,mice ,Physiology ,heart failure ,chemistry.chemical_element ,030204 cardiovascular system & hematology ,Calcium ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ca2+/calmodulin-dependent protein kinase ,medicine ,Eccentric ,Protein kinase A ,Ventricular remodeling ,030304 developmental biology ,0303 health sciences ,calcium ,CaMKII ,business.industry ,musculoskeletal, neural, and ocular physiology ,musculoskeletal system ,medicine.disease ,Endocrinology ,nervous system ,chemistry ,Heart failure ,cardiovascular system ,hypertrophy ,Cardiology and Cardiovascular Medicine ,business ,tissues - Abstract
Rationale: CaMKII (Ca 2+ -Calmodulin dependent protein kinase) δC activation is implicated in pathological progression of heart failure (HF) and CaMKIIδC transgenic mice rapidly develop HF and arrhythmias. However, little is known about early spatio-temporal Ca 2+ handling and CaMKII activation in hypertrophy and HF. Objective: To measure time- and location-dependent activation of CaMKIIδC signaling in adult ventricular cardiomyocytes, during transaortic constriction (TAC) and in CaMKIIδC transgenic mice. Methods and Results: We used human tissue from nonfailing and HF hearts, 4 mouse lines: wild-type, KO (CaMKIIδ-knockout), CaMKIIδC transgenic in wild-type (TG), or KO background, and wild-type mice exposed to TAC. Confocal imaging and biochemistry revealed disproportional CaMKIIδC activation and accumulation in nuclear and perinuclear versus cytosolic regions at 5 days post-TAC. This CaMKIIδ activation caused a compensatory increase in sarcoplasmic reticulum Ca 2+ content, Ca 2+ transient amplitude, and [Ca 2+ ] decline rates, with reduced phospholamban expression, all of which were most prominent near and in the nucleus. These early adaptive effects in TAC were entirely mimicked in young CaMKIIδ TG mice (6–8 weeks) where no overt cardiac dysfunction was present. The (peri)nuclear CaMKII accumulation also correlated with enhanced HDAC4 (histone deacetylase) nuclear export, creating a microdomain for transcriptional regulation. At longer times both TAC and TG mice progressed to overt HF (at 45 days and 11–13 weeks, respectively), during which time the compensatory Ca 2+ transient effects reversed, but further increases in nuclear and time-averaged [Ca 2+ ] and CaMKII activation occurred. CaMKIIδ TG mice lacking δB exhibited more severe HF, eccentric myocyte growth, and nuclear changes. Patient HF samples also showed greatly increased CaMKIIδ expression, especially for CaMKIIδC in nuclear fractions. Conclusions: We conclude that in early TAC perinuclear CaMKIIδC activation promotes adaptive increases in myocyte Ca 2+ transients and nuclear transcriptional responses but that chronic progression of this nuclear Ca 2+ -CaMKIIδC axis contributes to eccentric hypertrophy and HF.
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- 2020
32. Isolated atrial amyloidosis suspected by electrophysiological voltage mapping and diagnosed by 99m Tc‐DPD scintigraphy
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Imke Schatka, Burkert Pieske, Felix Kleefeld, Daniel Messroghli, Alexander Berger, Fabian Knebel, Jin-Hong Gerds-Li, Tobias Alexander, Doreen Schöppenthau, and Kathrin Hahn
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,Catheter ablation ,Case Reports ,Cardiac amyloidosis ,030204 cardiovascular system & hematology ,Scintigraphy ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine ,Voltage mapping ,Diseases of the circulatory (Cardiovascular) system ,Isolated atrial amyloidosis ,cardiovascular diseases ,030212 general & internal medicine ,DPD scan ,Fibrotic atrial cardiomyopathy ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Amyloidosis ,HFpEF ,medicine.disease ,RC666-701 ,Heart failure ,cardiovascular system ,Cardiology ,Atrial substrate ,Cardiology and Cardiovascular Medicine ,business ,Nuclear imaging - Abstract
We present not‐yet‐seen multimodal images of a 55‐year‐old female patient with isolated atrial amyloidosis (IAA) who clinically suffered from multiple atrial arrhythmias and heart failure symptoms with preserved left ventricular ejection fraction. We aim to show structural and functional abnormalities detected by electrophysiological voltage mapping, cardiac magnetic resonance imaging (MRI) [cMRI; atrial strain measurements, late gadolinium enhancement (LGE) visualization], and 99mTc‐DPD scintigraphy. Bipolar voltage mapping performed during two electrophysiological procedures showed diffuse left atrial low‐voltage areas (bipolar
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- 2020
33. 'Der Weg zu langlebigen und leistungsfähigeren Batteriesystemen'
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Andreas Burkert
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Engineering ,business.industry ,Ocean Engineering ,business ,Manufacturing engineering - Published
- 2020
34. Magnetic field-induced interactions between phones containing magnets and cardiovascular implantable electronic devices: Flip it to be safe?
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Frank R. Heinzel, Mohammad Sherif, Phi Long Dang, Florian Blaschke, Abdul Shokor Parwani, Felix Hohendanner, Haopeng Han, Thoralf Niendorf, Nandita Saha, Kerstin Rubarth, Philipp Lacour, Burkert Pieske, Felix Lucas Bähr, Faezeh Rahimi, Andreas Kucher, and Leif-Hendrik Boldt
- Subjects
Pacemaker, Artificial ,business.industry ,Minimum distance ,Independent predictor ,equipment and supplies ,Defibrillators, Implantable ,Magnetic Fields ,Cardiovascular and Metabolic Diseases ,Physiology (medical) ,Magnet ,Magnets ,Humans ,Medicine ,Binary logistic regression analysis ,Prospective Studies ,Electronics ,Technology Platforms ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Biomedical engineering - Abstract
Background Recent case reports and small studies have reported activation of the magnet-sensitive switches in cardiovascular implantable electronic devices (CIED) by the new iPhone 12 series, initiating asynchronous pacing in pacemakers and suspension of anti-tachycardia therapies in ICDs. Objective and Methods We performed a prospective single-center observational study to quantify the risk of magnetic field interactions of the iPhone 12 with CIEDs. A representative model of each CIED series from all manufacturers was tested ex vivo. Incidence and minimum distance necessary for magnet mode triggering were analyzed in 164 CIED patients with either the front or the back of the phone facing the device. The magnetic field of the iPhone 12 was analyzed using a 3-axis hall probe. Results Ex vivo, magnetic interferences occurred in 84.6% with the back compared to 46.2% with the front of the iPhone 12 facing the CIED. In vivo, activation of the magnet-sensitive switch occurred in 30 CIED patients (18.3%; 21 pacemaker, 9 ICDs) when the iPhone 12 was placed in close proximity over the CIED pocket and the back of the phone was facing the skin. Multiple binary logistic regression analysis identified the implantation depth (95% confidence interval [CI], 0.02 to 0.24) as independent predictor of magnet-sensitive switch activation. Conclusion Magnetic field interactions occur only in close proximity, and with precise alignment of the iPhone 12 and CIEDs. It is important to advise CIED patients to not put the iPhone 12 directly on the skin above the CIED. Further recommendations are not necessary.
- Published
- 2022
35. Biomarker-based assessment of collagen cross-linking identifies patients at risk of heart failure more likely to benefit from spironolactone effects on left atrial remodelling. Insights from the HOMAGE clinical trial
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Andrew L. Clark, Javier Díez, Pierpaolo Pellicori, Investigators, Nicolas Girerd, Job A J Verdonschot, João Pedro Ferreira, Susana Ravassa, Frank Edelmann, Stephane Heymans, Beatrice Mariottoni, María U. Moreno, Homage Trial Committees, Franco Cosmi, Jan A. Staessen, Burkert Pieske, John G.F. Cleland, Faiez Zannad, Johannes Petutschnigg, Mark R. Hazebroek, Joe Cuthbert, Arantxa González, Begoña López, Erwan Bozec, Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain, CIBERCV, Carlos III Institute of Health, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Department of Cardiology, Cortona Hospital, Department of Cardiology, Maastricht University Medical Center, Cardiology Department, Castle Hill Hospital, University of Hull, Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, and German Centre for Cardiovascular research (DZHK), Partner Site Berlin, Non-Profit Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen (APPREMED), Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Berlin Institute of Health (BIH), Departments of Nephrology and Cardiology, Clínica Universidad de Navarra, This work was supported by the European Commission HOMAGE project (grant 305507), JD and AG are supported by the Ministry of Science and Innovation, Spain (Instituto de Salud Carlos III: CB16/11/00483 and PI18/01469 co-financed by FEDER funds). MH is supported by a Kootstra Talented Post-doc Fellowship (Netherlands). JGFC and PP are supported by the British Heart Foundation Centre of Research Excellence (grant number RE/18/6/34217). PPREMED (URL: http://www.appremed.orf) received a non-binding grant from Omron Healthcare Co., Ltd., Kyoto, Japan., European Project: 305507, BOZEC, Erwan, HOMAGE (Heart Omics in Ageing consortium) - 305507 - INCOMING, MUMC+: MA Med Staf Artsass Cardiologie (9), RS: Carim - H02 Cardiomyopathy, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)
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Cardiac function curve ,medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,Heart failure ,030204 cardiovascular system & hematology ,Spironolactone ,EXERCISE CAPACITY ,Atrial remodelling ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,N-terminal telopeptide ,Left atrial ,Collagen cross-linking ,Internal medicine ,MAGNETIC-RESONANCE ,medicine ,FIBROSIS ,030212 general & internal medicine ,Science & Technology ,Ejection fraction ,business.industry ,medicine.disease ,DYSFUNCTION ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,PRESERVED EJECTION FRACTION ,chemistry ,VOLUME ,Cardiovascular System & Cardiology ,SURVIVAL ,Cardiology ,Biomarker (medicine) ,FIBRILLATION ,Cardiology and Cardiovascular Medicine ,business ,Life Sciences & Biomedicine ,Blood sampling - Abstract
Aims The HOMAGE randomized trial found that spironolactone reduced left atrial volume index (LAVI), E:A ratio, and a marker of collagen type I synthesis (procollagen type I C-terminal propeptide) in patients at risk of heart failure (HF). Previous trials showed that patients with HF, preserved ejection fraction and low serum collagen type I C-terminal telopeptide to matrix metalloproteinase-1 ratio (CITP:MMP-1), associated with high collagen cross-linking, had less improvement in diastolic function with spironolactone. We evaluated the interaction between serum CITP:MMP-1 and spironolactone on cardiac function in the HOMAGE trial.Methods and results Patients at risk of HF were randomized to spironolactone (n = 260) or not (n = 255). Blood sampling and echocardiography were done at baseline, one and nine months. CITP:MMP-1 was used as an indirect measure of collagen cross-linking. Higher baseline CITP:MMP-1 (i.e. lower collagen cross-linking) was associated with greater reductions in LAVI with spironolactone at both one (p = 0.003) and nine (p = 0.01) months, but no interaction was observed for E:A ratio. Spironolactone reduced LAVI after one and nine months only for those patients in the third tertile of CITP:MMP-1 (estimated lowest collagen cross-linking) [mean difference(sspiro/control): -1.77 (95% confidence interval, CI -2.94 to -0.59) and -2.52 (95% CI -4.46 to -0.58) mL/m(2); interaction p(across-tertiles) = 0.005; interaction p(third tertile) = 0.008] with a similar trend for N-terminal pro-B-type natriuretic peptide which was consistently reduced by spironolactone only in the lowest collagen cross-linking tertile [mean differences(spiro/control): -0.47 (95% CI -0.66 to -0.28) and -0.31 (95% CI -0.59 to -0.04) ng/L; interaction p(across-tertiles) = 0.09; interaction p(third tertile) < 0.001].Conclusions These findings suggest that, for patients at risk of HF, the effects of spironolactone on left atrial remodelling may be more prominent in patients with less collagen cross-linking (indirectly assessed by serum CITP:MMP-1).[GRAPHICS]Patients at risk of heart failure from the HOMAGE clinical trial were classified according to the baseline degree of myocardial collagen cross-linking, non-invasively assessed by the serum collagen type I C-terminal telopeptide (CITP) to matrix metalloproteinase-1 (MMP-1) ratio (CITP:MMP-1). As highly cross-linked collagen fibres are more resistant to degradation and CITP is a cross-linked peptide, for a given MMP-1 quantity less CITP will be released and, subsequently, serum CITP:MMP-1 will be lower. Whereas patients with low collagen cross-linking (high CITP:MMP-1) benefit from the cardioprotective effects of treatment with spironolactone on left atrial remodelling [i.e. a decrease in left atrial volume index (LAVI)] and on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, these beneficial effects are not found in patients with higher collagen cross-linking (low CITP:MMP-1).
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- 2022
36. Evaluation of high-sensitivity C-reactive protein and uric acid in vericiguat-treated patients with heart failure with reduced ejection fraction
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Sebastian Voss, Javed Butler, Lothar Roessig, Aldo P. Maggioni, Frank Kramer, Bernd Wolfgang Igl, Sanjiv J. Shah, Carolyn S.P. Lam, Burkert Pieske, and Cardiovascular Centre (CVC)
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Male ,Ventricular Ejection Fraction ,IMPACT ,030204 cardiovascular system & hematology ,Gastroenterology ,TREATMENT OF HFrEF ,Ventricular Function, Left ,DISEASE ,chemistry.chemical_compound ,0302 clinical medicine ,Interquartile range ,Vericiguat ,CACHEXIA ,Medicine ,Ventricular ejection fraction ,OXIDATIVE STRESS ,Research Articles ,Ejection fraction ,RIGHT-VENTRICULAR DYSFUNCTION ,biology ,Middle Aged ,C‐reactive protein ,STIMULATOR ,Female ,Cardiology and Cardiovascular Medicine ,Research Article ,medicine.medical_specialty ,Heart failure ,IMMUNITY ,Placebo ,Heterocyclic Compounds, 2-Ring ,C-reactive protein ,03 medical and health sciences ,INFLAMMATION ,Internal medicine ,SOLUBLE GUANYLATE-CYCLASE ,Humans ,Aged ,business.industry ,Stroke Volume ,Biomarker ,medicine.disease ,Pyrimidines ,chemistry ,biology.protein ,Uric acid ,business - Abstract
Aims: The effects of vericiguat vs. placebo on high-sensitivity C-reactive protein (hsCRP) and serum uric acid (SUA) were assessed in patients with heart failure with reduced ejection fraction (HFrEF) in the Phase 2 SOCRATES-REDUCED study (NCT01951625). Methods and results: Changes from baseline hsCRP and SUA values at 12 weeks with placebo and vericiguat (1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg, respectively) were assessed. The probability of achieving an hsCRP value of ≤3.0 mg/L or SUA value of
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- 2020
37. Short version of the 2nd edition of the German-Austrian S3 guidelines 'Cardiogenic shock complicating myocardial infarction—Diagnosis, monitoring and treatment'
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Guido Michels, M. Ruß, Alexander Geppert, Burkert Pieske, Kevin Pilarczyk, Matthias Thielmann, I. Kopp, Gerhard Hindricks, Stephan Willems, E. Pichler-Cetin, Uwe Zeymer, K. Werdan, Axel Schlitt, H. Figulla, Udo Boeken, Markus Ferrari, Johann Bauersachs, Uwe Janssens, Axel R. Heller, Holger Thiele, M. J. Briegel, Malte Kelm, Bernhard Zwißler, Roland Prondzinsky, G. Delle-Karth, and Michael Buerke
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Gynecology ,medicine.medical_specialty ,business.industry ,Medizin ,030208 emergency & critical care medicine ,General Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Medicine ,ddc:610 ,Cardiology and Cardiovascular Medicine ,business - Abstract
Diese Leitlinie ( http://leitlinien.net ) fokussiert ausschlieslich auf den infarktbedingten kardiogenen Schock (IKS). Beide Strategien, sowohl die kardiologisch/herzchirurgische als auch die intensivmedizinische, sind zur erfolgreichen Behandlung und zum Uberleben der Patienten mit IKS essenziell. Dennoch beschaftigen sich sowohl die europaischen als auch die amerikanischen Leitlinien zu Herzinfarkt und Herzinsuffizienz und auch die Positionspapiere zum kardiogenen Schock nahezu ausschlieslich mit den kardiologischen Aspekten. In einem nominalen Gruppenprozess der Delegierten der Deutschen Gesellschaft fur Kardiologie – Herz- und Kreislaufforschung (DGK), der Deutschen Gesellschaft fur Internistische Intensiv- und Notfallmedizin (DGIIN), der Deutschen Gesellschaft fur Thorax‑, Herz- und Gefaschirurgie (DGTHG), der Deutschen Gesellschaft fur Anasthesiologie und Intensivmedizin (DGAI), der Osterreichischen Gesellschaft fur Internistische und Allgemeine Intensivmedizin (OGIAIN), der Osterreichischen Kardiologischen Gesellschaft (OKG), der Deutschen Gesellschaft fur Pravention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR) und der Deutschen Interdisziplinaren Vereinigung fur Intensivmedizin (DIVI) wurden unter Leitung der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) die Evidenzen zur Diagnose, zum Monitoring und zur Therapie des IKS systematisch gesammelt und – darauf aufbauend – Empfehlungen ausgearbeitet. Lag jeweils nur geringe Evidenz zum IKS vor, wurden auch Studienergebnisse generell zu Intensivpatienten gesichtet und dargestellt, um Analogieschlusse zu erlauben. Es wurden 95 Empfehlungen – inklusive zweier Statements – erarbeitet und darauf basierend 7 Algorithmen mit konkreten Anweisungen zum Handlungsablauf.
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- 2020
38. Head‐to‐head comparison of cardiovascular MR feature tracking cine versus acquisition‐based deformation strain imaging using myocardial tagging and strain encoding
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Andreas Schuster, Shelby Kutty, Gerd Hasenfuß, Jennifer Erley, Joachim Lotz, Johannes T. Kowallick, Tomas Lapinskas, Burkert Pieske, Sören J. Backhaus, Victoria Zieschang, Georg Metschies, Seyedeh Mahsa Zamani, and Sebastian Kelle
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Head to head ,Intraclass correlation ,Heart Ventricles ,Magnetic Resonance Imaging, Cine ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,Deformation strain ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Consistency (statistics) ,Healthy volunteers ,Humans ,Radiology, Nuclear Medicine and imaging ,Reference standards ,Mathematics ,business.industry ,Myocardium ,Reproducibility of Results ,Magnetic Resonance Imaging ,Pearson product-moment correlation coefficient ,symbols ,Feature tracking ,Nuclear medicine ,business ,030217 neurology & neurosurgery - Abstract
Purpose Myocardial feature-tracking (FT) deformation imaging is superior for risk stratification compared with volumetric approaches. Because there is no clear recommendation regarding FT postprocessing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain-encoded (SENC) MRI. Methods Feature-tracking software from four different vendors (TomTec, Medis, Circle [CVI], and Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential strains (GCS) and longitudinal strains (GLS) in 12 healthy volunteers and 12 patients with heart failure. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as Pearson correlation coefficients. Results For FT-GCS, consistency was excellent comparing different FT vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and in comparison to fast SENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared with tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements among FT vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared with both tagging and fast SENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64), and lowest for TomTec (ICCa = 0.41 and 0.47). For FT-GLS, consistency was excellent (ICCc ≥ 0.86, r ≥ 0.76). Absolute agreements among FT vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared with tagging, but excellent compared with fast SENC (ICCa = 0.77-0.90). Conclusion Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high regardless of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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- 2020
39. Psychometric properties of the Japanese version of the Kansas City Cardiomyopathy Questionnaire in Japanese patients with chronic heart failure
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Lothar Roessig, Tetsumi Toyoda, Hideki Origasa, Luke Bamber, Chad Gwaltney, Yuri Haga, Burkert Pieske, and Emi Watanabe-Fujinuma
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Male ,medicine.medical_specialty ,Intraclass correlation ,Validity ,Heart failure ,030204 cardiovascular system & hematology ,lcsh:Computer applications to medicine. Medical informatics ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Cronbach's alpha ,Quality of life ,Surveys and Questionnaires ,Humans ,Medicine ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,Construct validity ,Functional status ,General Medicine ,Middle Aged ,medicine.disease ,humanities ,Kansas City Cardiomyopathy Questionnaire ,Clinical trial ,Psychometric properties ,Chronic Disease ,Quality of Life ,Physical therapy ,Japanese ,lcsh:R858-859.7 ,Female ,business - Abstract
Background Heart failure is a worldwide health problem that significantly affects patients’ physical function and health state. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a disease-specific patient-reported outcome measure commonly used for the assessment of health states of patients with heart failure. This study aimed to evaluate the psychometric properties of the Japanese version of the KCCQ. Methods Using pooled data of 141 Japanese patients with chronic heart failure from three clinical trials, the Japanese version of the KCCQ was evaluated for validity and reliability, with a focus on the clinical summary score (CSS) and its component domains. For construct validity, the associations of baseline KCCQ scores with New York Heart Association (NYHA) class and the EuroQol five-dimension, three-level (EQ-5D-3L) scores at baseline were analyzed. For reliability, internal consistency was assessed using Cronbach’s α, and test–retest reliability (reproducibility) was assessed among stable patients. Responsiveness to changes in patients’ clinical status was assessed by analyzing score changes between two timepoints among patients whose health states improved. Results Among 141 patients (mean age, 73.7 ± 10.9 years), 76.6% were NYHA class II at baseline. For CSS and its component domains (physical limitations, symptom frequency, and symptom severity), baseline scores were all significantly lower in patients with a higher NYHA class (p ρ = − 0.40 to − 0.54) with three functional status-related EQ-5D dimensions (mobility, self-care, and usual activities). The Cronbach’s standardized α was high (> 0.70) for all KCCQ domain/summary scores. In the test–retest analysis among 58 stable patients, all domain/summary scores minimally changed by 0.3–4.2 points with intraclass correlation coefficients of 0.65–0.84, demonstrating moderate to good reproducibility, except for the symptom stability domain. Among 44 patients with improved health states, all domain/summary scores except for the symptom stability and self-efficacy domains substantially improved from baseline with a medium to large effect size of 0.62–0.88. Conclusions The Japanese version of the KCCQ was demonstrated to be a valid and reliable tool for the assessment of symptoms and physical function of Japanese patients with chronic heart failure.
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- 2020
40. Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)
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Petar M. Seferovic, Subodh Verma, Hiroyuki Tsutsui, Jian Zhang, JoAnn Lindenfeld, John G.F. Cleland, Carolyn S.P. Lam, Johann Bauersachs, Eugene Braunwald, Giuseppe M.C. Rosano, Janet Wittes, Javed Butler, Stuart J. Pocock, Mandeep R. Mehra, Gerasimos Filippatos, Marco Metra, John J.V. McMurray, Muhammad Shahzeb Khan, Piotr Ponikowski, Vijay K. Chopra, Stefan D. Anker, Dirk J. van Veldhuisen, Andrew J.S. Coats, Adrian F. Hernandez, Burkert Pieske, Justin A. Ezekowitz, William T. Abraham, Edimar Alcides Bocchi, Tim Friede, John R. Teerlink, Biykem Bozkurt, Milton Packer, Faiez Zannad, Adriaan A. Voors, and Cardiovascular Centre (CVC)
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medicine.medical_specialty ,Social contract ,Clinical trials ,Coronavirus ,COVID-19 ,Heart failure ,Clinical Trials as Topic ,Europe ,Humans ,Informed Consent ,Patient Safety ,Patient Selection ,Research Design ,Betacoronavirus ,Coronavirus Infections ,Heart Failure ,Pandemics ,Pneumonia, Viral ,Clinical Sciences ,Cardiorespiratory Medicine and Haematology ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Internal medicine ,Pandemic ,Medicine ,Viral ,030212 general & internal medicine ,Association (psychology) ,business.industry ,Risk of infection ,Pneumonia ,medicine.disease ,3. Good health ,Clinical trial ,Cardiovascular System & Hematology ,Cardiology ,Position paper ,Cardiology and Cardiovascular Medicine ,business - Abstract
Author(s): Anker, Stefan D; Butler, Javed; Khan, Muhammad Shahzeb; Abraham, William T; Bauersachs, Johann; Bocchi, Edimar; Bozkurt, Biykem; Braunwald, Eugene; Chopra, Vijay K; Cleland, John G; Ezekowitz, Justin; Filippatos, Gerasimos; Friede, Tim; Hernandez, Adrian F; Lam, Carolyn SP; Lindenfeld, JoAnn; McMurray, John JV; Mehra, Mandeep; Metra, Marco; Packer, Milton; Pieske, Burkert; Pocock, Stuart J; Ponikowski, Piotr; Rosano, Giuseppe MC; Teerlink, John R; Tsutsui, Hiroyuki; Van Veldhuisen, Dirk J; Verma, Subodh; Voors, Adriaan A; Wittes, Janet; Zannad, Faiez; Zhang, Jian; Seferovic, Petar; Coats, Andrew JS | Abstract: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas.
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- 2020
41. 'Agricultural technology is system-relevant, worldwide'
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Andreas Burkert
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Engineering ,Agricultural machinery ,business.industry ,Interview ,General Medicine ,business ,Manufacturing engineering - Published
- 2020
42. 'Die Landtechnik ist weltweit systemrelevant'
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Andreas Burkert
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Engineering ,business.industry ,Titelthema ,General Medicine ,business ,Manufacturing engineering - Published
- 2020
43. Secretome Analysis of Cardiomyocytes Identifies PCSK6 (Proprotein Convertase Subtilisin/Kexin Type 6) as a Novel Player in Cardiac Remodeling After Myocardial Infarction
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Xue Li, Johannes Backs, Felix Lasitschka, Hugo A. Katus, Florian Sicklinger, Tim Christian Kuhn, Andreas Jungmann, Florian Leuschner, Jeroen Krijgsveld, Oliver J. Müller, Ingmar Sören Meyer, Sonja Burkert-Rettenmaier, and Johannes Knobel
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Male ,medicine.medical_specialty ,Proteome ,Myocardial Infarction ,Acute occlusion ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Animals ,Humans ,Medicine ,Myocytes, Cardiac ,Myocardial infarction ,Rats, Wistar ,Cells, Cultured ,030304 developmental biology ,0303 health sciences ,Secretory Pathway ,Ventricular Remodeling ,business.industry ,Subtilisin ,medicine.disease ,Proprotein convertase ,Mice, Inbred C57BL ,Disease Models, Animal ,medicine.anatomical_structure ,Animals, Newborn ,Cardiology ,Kexin ,Tissue necrosis ,Blood supply ,Proprotein Convertase 9 ,Cardiology and Cardiovascular Medicine ,business ,Signal Transduction ,Artery - Abstract
Background: Acute occlusion of a coronary artery results in swift tissue necrosis. Bordering areas of the infarcted myocardium can also experience impaired blood supply and reduced oxygen delivery, leading to altered metabolic and mechanical processes. Although transcriptional changes in hypoxic cardiomyocytes are well studied, little is known about the proteins that are actively secreted from these cells. Methods: We established a novel secretome analysis of cardiomyocytes by combining stable isotope labeling and click chemistry with subsequent mass spectrometry analysis. Further functional validation experiments included ELISA measurement of human samples, murine left anterior descending coronary artery ligation, and adeno-associated virus 9–mediated in vivo overexpression in mice. Results: The presented approach is feasible for analysis of the secretome of primary cardiomyocytes without serum starvation. A total of 1026 proteins were identified to be secreted within 24 hours, indicating a 5-fold increase in detection compared with former approaches. Among them, a variety of proteins have not yet been explored in the context of cardiovascular pathologies. One of the secreted factors most strongly upregulated upon hypoxia was PCSK6 (proprotein convertase subtilisin/kexin type 6). Validation experiments revealed an increase of PCSK6 on mRNA and protein level in hypoxic cardiomyocytes. PCSK6 expression was elevated in hearts of mice after 3 days of ligation of the left anterior descending artery, a finding confirmed by immunohistochemistry. ELISA measurements in human serum also indicate distinct kinetics for PCSK6 in patients with acute myocardial infarction, with a peak on postinfarction day 3. Transfer of PCSK6-depleted cardiomyocyte secretome resulted in decreased expression of collagen I and III in fibroblasts compared with control treated cells, and small interfering RNA–mediated knockdown of PCSK6 in cardiomyocytes impacted transforming growth factor-β activation and SMAD3 (mothers against decapentaplegic homolog 3) translocation in fibroblasts. An adeno-associated virus 9–mediated, cardiomyocyte-specific overexpression of PCSK6 in mice resulted in increased collagen expression and cardiac fibrosis, as well as decreased left ventricular function, after myocardial infarction. Conclusions: A novel mass spectrometry–based approach allows investigation of the secretome of primary cardiomyocytes. Analysis of hypoxia-induced secretion led to the identification of PCSK6 as being crucially involved in cardiac remodeling after acute myocardial infarction.
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- 2020
44. Clinical effectiveness of primary prevention implantable cardioverter-defibrillators: results of the EU-CERT-ICD controlled multicentre cohort study
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Zabel, Markus, Willems, Rik, Lubinski, Andrzej, Bauer, Axel, Brugada, Josep, Conen, David, Flevari, Panagiota, Hasenfuß, Gerd, Svetlosak, Martin, Huikuri, Heikki V, Malik, Marek, Pavlović, Nikola, Schmidt, Georg, Sritharan, Rajevaa, Schlögl, Simon, Szavits-Nossan, Janko, Traykov, Vassil, Tuinenburg, Anton E, Willich, Stefan N, Harden, Markus, Friede, Tim, Svendsen, Jesper Hastrup, Sticherling, Christian, Merkely, Béla, Perge, Peter, Sallo, Zoltan, Szeplaki, Gabor, Szegedi, Nandor, Nagy, Klaudia Vivien, Lüthje, Lars, Sritharan, R, Haarmann, Helge, Bergau, Leonard, Seegers, Joachim, Munoz- Exposito, Pascal, Tichelbäcker, Tobias, Kirova, Aleksandra, Hnatkova, Katerina, Vos, Marc A, Reinhold, Thomas, Vandenberk, Bert, Klinika, Magdalena, Rotkvić, L, Flevari, Panayota, Katsimardos, Andreas, Katsaras, Dimitrios, Hatala, Robert, Kuczejko, Tomasz, Hansen, Jim, Manola, Šime, Vinter, Ozren, Benko, Ivica, Tuinenburg, Anton, Sprenkeler, David, Smoczynska, A, Vos, M A, Meyer-Zürn, Christine, Eick, Christian, Arbelo, Elena, Kaliska, Gabriela, Martinek, Jozef, Dommasch, Michael, Steger, Alexander, Kääb, Stefan, Sinner, Moritz F, Rizas, Konstantinos D, Hamm, Wolfgang, Traykov, V, Cygankiewicz, Iwona, Ptaszyński, Pawel, Kaczmarek, K, Poddebska, I, Iovev, Svetoslav, Novotný, Tomáš, Kozak, Milan, Huikuri, Heikki, Kenttä, Tuomas, Pelli, Ari, Kasprzak, Jaroslaw D, Qavoq, Dariusz, Brusich, Sandro, Avdovic, Ervin, Klasan, Marina, Galuszka, Jan, Taborsky, Milos, Velchev, Vasil, Dissmann, Rüdiger, Shalganov, T, Guzik, P, Krauze, T, Bimmel, Dieter, Lieberz, Christiane, Ludwigsburg, Klinikum, Stefanow, Stefan, Rüb, Norman, Wolpert, Christian, Meier, Lars S, Behrens, Steffen, Jurisic, Zrinka, Braunschweig, Frieder, Blaschke, Florian, Pieske, Burkert, Bakotic, Zoran, Anic, Ante, Weiden, Klinikum, Schwinger, Robert H G, Platonov, Pyotr, Grönefeld, Gerian, Klingenheben, Thomas, and EU-CERT-ICD Study Investigators
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Implantable cardioverter-defibrillator ,Risk factors ,Mortality ,Sudden cardiac death ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Cohort Studies ,EU-CERT-ICD Study Investigators ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,AcademicSubjects/MED00200 ,Prospective Studies ,030212 general & internal medicine ,BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine ,1102 Cardiorespiratory Medicine and Haematology ,Aged ,BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina ,Heart Failure ,Ejection fraction ,Ischemic cardiomyopathy ,business.industry ,Hazard ratio ,Stroke Volume ,1103 Clinical Sciences ,Dilated cardiomyopathy ,medicine.disease ,Confidence interval ,Defibrillators, Implantable ,3. Good health ,Europe ,Primary Prevention ,Death, Sudden, Cardiac ,Treatment Outcome ,Cardiovascular System & Hematology ,Implantable cardioverter-defibrillator, Risk factors, Mortality, Sudden cardiac death ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Aims The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter-Defibrillators (EU-CERT-ICD), a prospective investigator-initiated, controlled cohort study, was conducted in 44 centres and 15 European countries. It aimed to assess current clinical effectiveness of primary prevention ICD therapy. Methods and results We recruited 2327 patients with ischaemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and guideline indications for prophylactic ICD implantation. Primary endpoint was all-cause mortality. Clinical characteristics, medications, resting, and 12-lead Holter electrocardiograms (ECGs) were documented at enrolment baseline. Baseline and follow-up (FU) data from 2247 patients were analysable, 1516 patients before first ICD implantation (ICD group) and 731 patients without ICD serving as controls. Multivariable models and propensity scoring for adjustment were used to compare the two groups for mortality. During mean FU of 2.4 ± 1.1 years, 342 deaths occurred (6.3%/years annualized mortality, 5.6%/years in the ICD group vs. 9.2%/years in controls), favouring ICD treatment [unadjusted hazard ratio (HR) 0.682, 95% confidence interval (CI) 0.537–0.865, P = 0.0016]. Multivariable mortality predictors included age, left ventricular ejection fraction (LVEF), New York Heart Association class Conclusion In contemporary ICM/DCM patients (LVEF ≤35%, narrow QRS), primary prophylactic ICD treatment was associated with a 27% lower mortality after adjustment. There appear to be patients with less survival advantage, such as older patients or diabetics.
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- 2020
45. Japans mobile Gesellschaft 5.0
- Author
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Andreas Burkert
- Subjects
Engineering ,business.industry ,Automotive Engineering ,Ocean Engineering ,business ,Manufacturing engineering - Published
- 2020
46. Circulating uromodulin inhibits vascular calcification by interfering with pro-inflammatory cytokine signalling
- Author
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Kai-Uwe Eckardt, Trang T.D. Luong, Ioana Alesutan, Norbert Frey, Jaber Masyout, Juergen E. Scherberich, Nicolas Verheyen, Stefan Pilz, Florian Lang, Oliver J. Müller, Markus P. Schneider, Jakob Voelkl, Misael Estepa, Andreas Tomaschitz, Nadeshda Schelski, Christian Delles, Andreas Pasch, Delyth Graham, Daniel Zickler, Winfried Maerz, Burkert Pieske, and Susanne Hille
- Subjects
Male ,0301 basic medicine ,Tamm–Horsfall protein ,Physiology ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Muscle, Smooth, Vascular ,chemistry.chemical_compound ,0302 clinical medicine ,Osteogenesis ,Aorta ,Cells, Cultured ,Mice, Knockout ,Kidney ,Protein Carbamylation ,biology ,Middle Aged ,Phenotype ,medicine.anatomical_structure ,Cytokine ,Mice, Inbred DBA ,Cytokines ,Female ,Tumor necrosis factor alpha ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,Chondrogenesis ,Signal Transduction ,Adult ,medicine.medical_specialty ,Myocytes, Smooth Muscle ,Renal function ,Young Adult ,03 medical and health sciences ,Physiology (medical) ,Internal medicine ,Uromodulin ,medicine ,Animals ,Humans ,Renal Insufficiency, Chronic ,Vascular Calcification ,Aged ,business.industry ,medicine.disease ,Mice, Inbred C57BL ,Disease Models, Animal ,030104 developmental biology ,Endocrinology ,chemistry ,Cell Transdifferentiation ,biology.protein ,business ,Cholecalciferol ,Kidney disease ,Calcification - Abstract
Aims Uromodulin is produced exclusively in the kidney and secreted into both urine and blood. Serum levels of uromodulin are correlated with kidney function and reduced in chronic kidney disease (CKD) patients, but physiological functions of serum uromodulin are still elusive. This study investigated the role of uromodulin in medial vascular calcification, a key factor associated with cardiovascular events and mortality in CKD patients. Methods and results Experiments were performed in primary human (HAoSMCs) and mouse (MOVAS) aortic smooth muscle cells, cholecalciferol overload and subtotal nephrectomy mouse models and serum from CKD patients. In three independent cohorts of CKD patients, serum uromodulin concentrations were inversely correlated with serum calcification propensity. Uromodulin supplementation reduced phosphate-induced osteo-/chondrogenic transdifferentiation and calcification of HAoSMCs. In human serum, pro-inflammatory cytokines tumour necrosis factor α (TNFα) and interleukin-1β (IL-1β) co-immunoprecipitated with uromodulin. Uromodulin inhibited TNFα and IL-1β-induced osteo-/chondrogenic signalling and activation of the transcription factor nuclear factor kappa-light-chain-enhancer of activated β cells (NF-kB) as well as phosphate-induced NF-kB-dependent transcriptional activity in HAoSMCs. In vivo, adeno-associated virus (AAV)-mediated overexpression of uromodulin ameliorated vascular calcification in mice with cholecalciferol overload. Conversely, cholecalciferol overload-induced vascular calcification was aggravated in uromodulin-deficient mice. In contrast, uromodulin overexpression failed to reduce vascular calcification during renal failure in mice. Carbamylated uromodulin was detected in serum of CKD patients and uromodulin carbamylation inhibited its anti-calcific properties in vitro. Conclusions Uromodulin counteracts vascular osteo-/chondrogenic transdifferentiation and calcification, at least in part, through interference with cytokine-dependent pro-calcific signalling. In CKD, reduction and carbamylation of uromodulin may contribute to vascular pathology.
- Published
- 2020
47. Japan's Mobile Society 5.0
- Author
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Andreas Burkert
- Subjects
Engineering ,business.industry ,General Earth and Planetary Sciences ,General Medicine ,business ,Telecommunications ,General Environmental Science - Published
- 2020
48. Effects of Sacubitril-Valsartan Versus Valsartan in Women Compared With Men With Heart Failure and Preserved Ejection Fraction Insights From PARAGON-HF
- Author
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Faiez Zannad, Inder S. Anand, Victor Shi, Marty P. Lefkowitz, Małgorzata Lelonek, Scott D. Solomon, Junbo Ge, Alice M Jackson, Milton Packer, Dirk J. van Veldhuisen, Annamaria Kosztin, Sanjiv J. Shah, Maja Cikes, Brian Claggett, Felipe Martinez, Adel R. Rizkala, Eva Goncalvesova, Marc A. Pfeffer, Shalini V. Sabarwal, Pardeep S. Jhund, Margaret M. Redfield, Michael R. Zile, Tzvetana Katova, Burkert Pieske, John J.V. McMurray, Carolyn S.P. Lam, Nancy K. Sweitzer, Amil M. Shah, Aldo P. Maggioni, Orly Vardeny, and Cardiovascular Centre (CVC)
- Subjects
Male ,medicine.medical_specialty ,SEX-DIFFERENCES ,PATHOPHYSIOLOGY ,Tetrazoles ,heart failure ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,GUIDELINES ,neprilysin ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,NEPRILYSIN INHIBITION ,MORBIDITY ,Sex Factors ,0302 clinical medicine ,AGE ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Neprilysin ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,Aminobutyrates ,MORTALITY ,Biphenyl Compounds ,Stroke Volume ,Middle Aged ,medicine.disease ,DYSFUNCTION ,Drug Combinations ,Valsartan ,Heart failure ,Cardiology ,Female ,women ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business ,Sacubitril, Valsartan ,medicine.drug ,hospitalization - Abstract
Background: Unlike heart failure with reduced ejection fraction, there is no approved treatment for heart failure with preserved ejection fraction, the predominant phenotype in women. Therefore, there is a greater heart failure therapeutic deficit in women compared with men. Methods: In a prespecified subgroup analysis, we examined outcomes according to sex in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction), which compared sacubitril-valsartan and valsartan in patients with heart failure with preserved ejection fraction. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and death from cardiovascular causes. We also report secondary efficacy and safety outcomes. Results: Overall, 2479 women (51.7%) and 2317 men (48.3%) were randomized. Women were older and had more obesity, less coronary disease, and lower estimated glomerular filtration rate and NT-proBNP (N-terminal pro–B-type natriuretic peptide) levels than men. For the primary outcome, the rate ratio for sacubitril-valsartan versus valsartan was 0.73 (95% CI, 0.59–0.90) in women and 1.03 (95% CI, 0.84–1.25) in men ( P interaction = 0.017). The benefit from sacubitril-valsartan was attributable to reduction in heart failure hospitalization. The improvement in New York Heart Association class and renal function with sacubitril-valsartan was similar in women and men, whereas the improvement in Kansas City Cardiomyopathy Questionnaire clinical summary score was less in women than in men. The difference in adverse events between sacubitril-valsartan and valsartan was similar in women and men. Conclusions: As compared with valsartan, sacubitril-valsartan seemed to reduce the risk of heart failure hospitalization more in women than in men. Whereas the possible sex-related modification of the effect of treatment has several potential explanations, the present study does not provide a definite mechanistic basis for this finding. Clinical Trial Registration: https://www.clinicaltrials.gov . Unique identifier: NCT01920711.
- Published
- 2020
49. Periodontitis and cardiovascular diseases. Consensus report
- Author
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Thomas Dietrich, Iain L. C. Chapple, David Herrera, Burkert Pieske, Mariano Sanz, Alvaro Marco del Castillo, Philippe Bouchard, José Ramón González-Juanatey, Søren Jepsen, Lior Shapira, Phoebus N. Madianos, Charalambos Vlachopoulos, Francesco D'Aiuto, Israel Gotsman, Bruno G. Loos, Filippo Graziani, Gernot Wimmer, Jean-Baptiste Michel, Maurizio S. Tonetti, Pablo Perel, Michael Shechter, and Periodontology
- Subjects
medicine.medical_specialty ,chronic inflammation ,lcsh:Diseases of the circulatory (Cardiovascular) system ,anti thrombotic therapy ,Consensus ,bateremia ,Epidemiology ,Population ,Disease ,antitrombotic therapy ,030204 cardiovascular system & hematology ,Severe periodontitis ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,cardiovascular disease ,medicine ,Humans ,030212 general & internal medicine ,bacteremia ,Intensive care medicine ,education ,Stroke ,periodontitis ,Periodontal Diseases ,Community and Home Care ,Periodontitis ,education.field_of_study ,business.industry ,Incidence ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,030206 dentistry ,Periodontology ,medicine.disease ,periodontal therapy ,cardiovascular diseases ,atherosclerosis ,Europe ,lcsh:RC666-701 ,Heart failure ,Periodontics ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Expert Consensus Document - Abstract
Background: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease. Material and Methods: There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations. Results and Conclusions: The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.
- Published
- 2020
50. Predictive value of metabolomic biomarkers for cardiovascular disease risk: a systematic review and meta-analysis
- Author
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Jasmin Radenkovic, Doris Bach, Leonhard Schleußner, Tobias Daniel Trippel, Frank Edelmann, Burkert Pieske, Muni Rubens, Peter McGranaghan, and Anshul Saxena
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Oncology ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Clinical Biochemistry ,Subgroup analysis ,Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Metabolomics ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,business.industry ,Guideline ,Prognosis ,Precision medicine ,Predictive value ,Cardiovascular Diseases ,030220 oncology & carcinogenesis ,Meta-analysis ,Disease risk ,business ,Biomarkers - Abstract
Background: Metabolomic analysis aids in the identification of novel biomarkers by revealing the metabolic dysregulations underlying cardiovascular disease (CVD) aetiology. The aim of this study was to evaluate which metabolic biomarkers could add value for the prognosis of CVD events using meta-analysis.Methods: The PRISMA guideline was followed for the systematic review. For the meta-analysis, biomarkers were included if they were tested in multivariate prediction models for fatal CVD outcomes. We grouped the metabolites in biological classes for subgroup analysis. We evaluated the prediction performance of models which reported discrimination and/or reclassification statistics.Results: For the systematic review, there were 22 studies which met the inclusion/exclusion criteria. For the meta-analysis, there were 41 metabolites grouped into 8 classes from 19 studies (45,420 subjects, 5954 events). A total of 39 of the 41 metabolites were significant with a combined effect size of 1.14 (1.07-1.20). For the predictive performance assessment, there were 21 studies, 54,337 subjects, 6415 events. The average change in c-statistic after adding the biomarkers to a clinical model was 0.0417 (SE 0.008).Conclusions: This study provides evidence that metabolomic biomarkers, mainly lipid species, have the potential to provide additional prognostic value. Current data are promising, although approaches and results are heterogeneous.
- Published
- 2020
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